Background:There are increasing reports of Raoultella ornithinolytica infection in humans. This study reports significant contribution of Raoultella ornithinolytica to neonatal gut microbiota. Methods:Rectal swab samples were collected in 70 healthy neonates, within 6-12hours of birth, and days 3, 9, and 14 after birth. Colonization by R. ornithinolytica was evaluated against neonatal characteristics. Results:Among the 70 neonates, R. ornithinolytica was the fourth most common bacteria isolated. R. ornithinolytica was part of gut microbiota at birth, and on Day 3, Day 9 and Day 14 after birth in 15%, 28.6%, 21.4% and 5.7% of neonates respectively. No factor was associated with R. ornithinolytica colonization, but a trend towards an increased likelihood of colonization among females, asphyxiated and neonates whose mothers had prolonged labour was observed. Conclusion:R. ornithinolytica has emerged as an important part of gut microbiota among neonates in Nigeria, but its' role in neonatal dysbiosis and infection remains unclear.
Background: The psychosocial burden of Diabetes Mellitus (DM) and its debilitating consequences could result in depression and anxiety. Several studies had been conducted on depression alone among diabetics in Nigeria. However, only few studies in addition to depression have explored the prevalence of anxiety and anxiety comorbidity with depression. Aim: To determine the prevalence and factors associated with anxiety or depression among Type 2 DM patients. Methods: This was a hospital based cross-sectional survey. Systematic random technique was used to select 273 Type 2DM patients aged 40 years and above attending a secondary health facility in Ibadan, Nigeria. Depression and anxiety were assessed by using Zung’s Self Depression Rating Scale and Beck Anxiety Inventory respectively. Data was analyzed using the Chi square test and multivariate logistic regression with a P value set at 0.05. Results: The mean age of the respondents was 62.1 (+10.2) years and majority were female (85.3%). The prevalence of depression, anxiety and comorbidity of depression and anxiety were 27.5%, 16.5% and 4.4% respectively. Physical inactivity and uncontrolled blood glucose were found among 48.4% and 61.5% respondents respectively. Depression was significantly associated with physical inactivity [OR=0.58; 95% CI=0.34-0.93] and low-moderate social support [OR=1.85; 95% CI=1.08-3.17], while anxiety was significantly associated with religion. The predictors of depression and anxiety were low social support (OR=0.58; 95% CI=0.33-0.95 p=0.04) and Christianity (OR=2.25; 95% CI=1.10-4.61, P=0.03) respectively. Conclusion: We recommend that clinicians should screen Type 2 DM patients for depression and anxiety, assess their level of social support, educate on the importance of physical activity and encourage physical activity. Keyword: Depression, Anxiety, Type 2 Diabetes Mellitus, Comorbidity, Social support. ResumeContexte: Le fardeau psychosocial du diabete sucre (DM) et ses consequences debilitantes pourraient entrainer la depression et l’anxiete. Plusieurs etudes ont ete menees sur la depression seule chez les diabetiques au Nigeria. Cependant, seulement peu d’etudes en plus de la depression ont explore la prevalence de l’anxiete et l’anxiete comorbidite avec la depression. Objectif: Determiner la prevalence et les facteurs associes a l’anxiete ou a la depression chez les patients atteints de DM de type 2. Methodes: Il s’agissait d’une enquete transversale en milieu hospitalier. Une technique aleatoire systematique a ete utilisee pour selectionner 273 patients de type 2DM âges de 40 ans et plus frequentant un etablissement de sante secondaire a Ibadan, au Nigeria. La depression et l’anxiete ont ete evaluees en utilisant l’echelle d’evaluation de l’autodefre depression de Zung et l’inventaire de l’anxiete Beck respectivement. Les donnees ont ete analysees a l’aide du test chi carre et de la regression logistique multivariee avec une valeur P fixee a 0,05.Resultats: L’âge moyen des repondants etait de 62,1 ans (+10,2 ans) et la majorite etait une femme (85,3 %). La prevalence de la depression, de l’anxiete et de la comorbidite de la depression et de l’anxiete etait de 27,5 %, 16,5 % et 4,4 % respectivement. L’inactivite physique et la glycemie incontrolee ont ete trouvees parmi 48,4 % et 61,5 % des repondants respectivement. La depression etait significativement associee a l’inactivite physique [OR=0,58; IC a 95 %=0,34-0,93] et a un soutien social faiblement modere [OR=1,85; IC a 95 %=1,08-3,17], tandis que l’anxiete etait significativement associee a la religion. Les predicteurs de la depression et de l’anxiete etaient un faible soutien social (OR=0,58; IC a 95 %=0,33-0,95 p=0,04) et christianisme (OR=2,25; IC a 95 %=1,10-4,61, P=0,03) respectivement. Conclusion: Nous recommandons aux cliniciens de depister la depression et l’anxiete chez les patients de type 2, d’evaluer leur niveau de soutien social, d’eduquer sur l’importance de l’activite physique et d’encourager l’activite physique. Mots-cles: Depression, Anxiete, Diabete sucre de type 2, Comorbidite, Soutien social. Correspondence: Prof. Olufunmilayo I. Fawole, Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Email address: fawoleo@ymail.com; Tel:08032180302
Background: Metabolic Syndrome (MS) and Autoimmune thyroid diseases (ATD) are characterized by common abnormalities - abdominal obesity, hyperglycemia, hypertension, and elevated triglyceride, and may compound the risk for atherosclerotic cardiovascular disease. The prevalence of MS in ATD, the association of these diseases, the specific common metabolic abnormalities and the influence of gender were investigated in this study. Methods: This was a case control study where 230 individuals within the age range of 18 – 70 years, comprising of 130 participants with ATD {Hashimoto’s Thyroiditis (HT) (30); Graves’ disease (GD) (100)} attending endocrine clinics of two tertiary hospitals in North Western Nigeria, where conveniently enrolled together with age matched 100 apparently healthy individuals without MS, to serve as controls. Enzymatic methods were used for estimation of glucose and lipids while enzyme immunoassay methods were used for the thyroid hormones and antibodies. Data analysed were considered significant at p<0.05. Results: ATD was significantly associated with MS (p<0.001). However, the influence of gender on this association was demonstrated in participants with GD only (p < 0.001). 30.8% (40) participants with ATD had MS. The prevalence of MS in participants with HT and GD were 33.3% (10) and 30% (30). Individual MS components; abdominal obesity (80% vs 53%), hypertension (36.7% vs 74%), dysglycemia (16.7% vs 16.0%), hypertriglyceridaemia (23.3% vs 14%) and reduced HDL-C (50% vs 51%) were observed in participants with HT and GD respectively. Conclusion: The most frequent cluster of MS components in the participants with HT and GD was increased waist circumference (WC), reduced HDL-C and hypertension. Prevalence of MS and its components is high. Metabolic Syndrome is associated with ATD and influenced by gender. Keywords: Atherosclerotic Cardiovascular Disease, Abdominal Obesity, Gender, Prevalence, Thyroid Diseases Resume Contexte: Le syndrome metabolique (SEP) et les maladies thyroidiennes auto-immunes (ATD) sont caracterises par des anomalies communes - obesite abdominale, hyperglycemie, hypertension, et triglyceride eleve, et peuvent aggraver le risque de maladie cardio-vasculaire atherosclerostique. La prevalence de la SP dans la MALADIE, l’association de ces maladies, les anomalies metaboliques communes specifiques et l’influence du genre ont ete etudiees dans cette etude. Methodes: Il s’agissait d’une etude de cas ou 230 personnes dans la gamme d’âge de 18 a 70 ans, comprenant de 130 participants avec ATD {Hashimoto’ Thyroidite de s (HT) (30); Graves’ maladie (GD) (100)} frequentant les cliniques endocriniennes de deux hopitaux tertiaires dans le nord-ouest du Nigeria, ou commodement inscrits avec l’âge correspondait a 100 personnes apparemment en bonne sante sans SP, pour servir de controles. Des methodes enzymatiques ont ete employees pour l’estimation du glucose et des lipides tandis que des methodes d’immunoassay d’enzyme ont ete employees pour les hormones thyroidiennes et les anticorps. Les donnees analysees ont ete jugees significatives < 0,05 p. 2005. Resultats: L’ATD a ete significativement associe a la SP (p<0,001). Cependant, l’influence du genre sur cette association a ete demontree chez les participants avec GD seulement (p < 0,001). 30,8 % (40) participants atteints de DTS etaient atteints de SP. La prevalence de la SP chez les participants atteints d’HT et de DT etait de 33,3 % (10) et de 30 % (30). Composantes individuelles de la SP; obesite abdominale (80 % vs 53 %), hypertension (36,7 % vs 74 %), dysglycemie (16,7 % vs 16,0 %), hypertriglyceridaemia (23,3 % vs 14 %) et reduction du HDL-C (50 % vs 51 %) ont ete observes chez les participants ayant respectivement ht et GD. Conclusion: Le groupe le plus frequent de composants de SP chez les participants atteints d’HT et de DT a ete l’augmentation de la circonference de la taille (WC), la reduction du HDL-C et de l’hypertension. La prevalence de la SP et de ses composantes est elevee. Le syndrome metabolique est associe a l’ATD et influence par le sexe. Mots-cles: Maladies cardiovasculaires atheroclerotiques, Obesite abdominale, Sexe, Prevalence, Maladies thyroidiennes Correspondence: Rosemary A. Nwaelugo, Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria. Email: nwaelugorosemary@gmail.com
Background: The number of ciprofloxacin hydrochloride brands in the Nigerian market is continuously increasing; hence, there is need to establish their bioequivalence in the interest of public health. This study assessed the chemical, biopharmaceutical, and microbiological profile of thirty brands of ciprofloxacin (500 mg) tablets in Nigerian market. Method: Quality parameters evaluated include weight uniformity, thickness and diameter, hardness, friability, disintegration, dissolution, identity, and antibacterial profile. Content of active ingredients was determined by a slightly modified and validated HPLC method. Results: Results of thickness, diameter, and hardness tests of all the brands fell within acceptable limits. The percentage of brands within acceptable range for weight uniformity, friability, disintegration, dissolution, and active ingredient are 86.67, 96.67, 93.33, 26.67, and 93.33% respectively. About 87% of the tested generic version of ciprofloxacin demonstrated in-vitro antibacterial bioequivalence to the reference drug. The abysmal low dissolution rate of 26.67 % is a source of concern as it suggests a potential poor bioavailability of the active ingredient of these drugs. Conclusion: The failure of a large portion of the tested brands may be due to deliberate counterfeiting, failure of current good manufacturing practices (cGMP) by manufacturers or poor handling by wholesalers/retailers. The study therefore recommends effective post marketing surveillance and enforcement of cGMP by the concerned regulatory agency in Nigeria. Keywords: Bioequivalence, ciprofloxacin, quality, GMP, drug faking, and infectious diseases ResumeContexte: Le nombre de marques de chlorhydrate de ciprofloxacine sur le marche nigerian ne cesse d’augmenter; par consequent, il est necessaire d’etablir leur bioequivalence dans l’interet de la sante publique. Cette etude a evalue le profil chimique, biopharmaceutique et microbiologique de trente marques de comprimes de ciprofloxacine (500 mg) sur le marche nigerian. Methode: Les parametres de qualite evalues comprennent l’uniformite du poids, l’epaisseur et le diametre, la durete, la friabilite, la desintegration, la dissolution, l’identite et le profil antibacterien. La teneur en ingredients actifs a ete determinee par une methode HPLC legerement modifiee et validee. Resultats: Les resultats des tests d’epaisseur, de diametre et de durete de toutes les marques se situaient dans des limites acceptables. Le pourcentage de marques dans la plage acceptable pour l’uniformite du poids, la friabilite, la desintegration, la dissolution et l’ingredient actif est de 86,67, 96,67, 93,33, 26,67 et 93,33% respectivement. Environ 87% de la version generique testee de la ciprofloxacine a demontre une bioequivalence antibacterienne in vitro avec le medicament de reference. Le faible taux de dissolution abyssal de 26,67% est une source de preoccupation car il suggere une mauvaise biodisponibilite potentielle de l’ingredient actif de ces medicaments. Conclusion: L’echec d’une grande partie des marques testees peut etre du a une contrefacon deliberee, a un echec des bonnes pratiques de fabrication actuelles (cGMP) par les fabricants ou a une mauvaise manipulation par les grossistes / detaillants. L’etude recommande donc une surveillance post-commercialisation efficace et l’application des BPF par l’organisme de reglementation concerne au Nigeria. Mots cles: Bioequivalence, ciprofloxacine, qualite, BPF, contrefacon de medicaments et maladies infectieuses Correspondence: Dr. Olufunmilayo E. Adejumo, Department of Pharmaceutical and Medicinal Chemistry, Olabisi Onabanjo University, Sagamu, Nigeria. E-mail: funmilayo@yahoo.co.uk
Introduction: The Lumbar Spinal Canal (LSC) dimension is known to vary among races, and is marginally smaller in blacks than in whites. The average diameters of 16mm for anteroposterior (AP) and 20mm for transverse diameters were derived in the past from studies on bone specimens and radiographs, and more recently from Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). These investigation modalities which are most accurate for LSC dimensions were largely on Caucasian populations. As a result, there is a lack of consensus among spine surgeons as to what constitutes radiological narrowing of the lumbar spine in people of black heritage. Objectives: To describe the normal spinal canal dimension using CT scan images of people of a black population in Nigeria. Research Design: This was a retrospective study that measured lumbar spinal canal parameters from abdominal CT scan images. Methodology: It evaluated 120 abdominal CT scan images done between July 1st, 2017 and June 30th, 2019 at Lagoon Hospitals, Lagos. Data collection was on a structured proforma and subjected to statistical analysis. Results: The mean anteroposterior diameter, APD was 15.8 (SD ±2.0)mm. The mean transverse diameter, TD was 25.82 (SD ± 2.4)mm. The mean Vertebral Torg ratio was 0.62. The narrowest APD of the lumbar canal was at L3 for both sexes while the widest point of the canal in males was at L1, and at L5 in females. The narrowest TD was at L1 while the widest point was at L5. The prevalence of developmental lumbar canal stenosis was 2.67%. Conclusion: The average APD of the lumbar canal in Nigerians is 15.8 (SD ± 2)mm. The narrowest point of the lumbar canal is at L3. Keywords: Lumbar Spinal canal, Nigerians, CT scan, stenosis ResumeContexte: La dimension du canal rachidien lombaire (LSC) est connue pour varier selon les races, et est legerement plus petite chez les noirs que chez les blancs. Les diametres moyens de 16 mm pour les diametres antero-posterieur (AP) et 20 mm pour les diametres transversaux ont ete derives dans le passe d’etudes sur des echantillons osseux et des radiographies, et plus recemment de la tomographie par ordinateur (CT) et de l’imagerie par resonance magnetique (IRM). Ces modalites d’enquete qui sont les plus precises pour les dimensions LSC etaient en grande partie sur les populations de race Blanche. En consequence, il y a un manque de consensus parmi les chirurgiens de la colonne vertebrale sur ce qui constitue un retrecissement radiologique de la colonne lombaire chez les personnes d’origine noire. Objectifs: Decrire la dimension normale du canal rachidien a l’aide d’images tomodensitometriques de personnes d’une population noire au Nigeria. Conception de la recherche: Il s’agissait d’une etude retrospective qui mesurait les parametres du canal rachidien lombaire a partir d’images tomodensitometriques abdominales. Methodologie: Il a evalue 120 images de tomodensitometrie abdominale realisees entre le 1er juillet 2017 et le 30 juin 2019 dans les hopitaux Lagoon de Lagos. La collecte des donnees a ete effectuee sur un formulaire structure et soumise a une analyse statistique. Resultats: Le diametre anteroposterieur moyen, APD etait de 15,8 (ET ± 2,0) mm. Le diametre transversal moyen, TD etait de 25,82 (ET ± 2,4) mm. Le ratio moyen de Torg vertebral etait de 0,62. La DPA la plus etroite du canal lombaire etait a L3 pour les deux sexes tandis que le point le plus large du canal chez les mâles etait a L1 et a L5 chez les femelles. Le TD le plus etroit etait a L1 tandis que le point le plus large etait a L5. La prevalence de la stenose developpementale du canal lombaire etait de 2,67%. Conclusion: L’APD moyenne du canal lombaire chez les Nigerians est de 15,8 (SD ± 2) mm. Le point le plus etroit du canal lombaire est en L3. Mots cles: canal rachidien lombaire, Nigerians, tomodensitometrie, stenose Correspondence: Dr. O. J. Alonge, Department of Orthopedics, University College Hospital, Ibadan. Nigeria. E-mail: kunle.alonge@yahoo.co.uk
Department of Child Oral Health, College of Medicine, University of Ibadan, Ibadan, NigeriaAbstractA case of bilaterally impacted maxillary permanent canines with associated left maxillary compound odontoma with cortical bone swelling obstructing the path of eruption of the left permanent maxillary canine and retention of primary canine on the right maxillary anterior segment. Management was by extraction of the right maxillary primary canine, surgical excision of the compound odontoma on the left maxillary anterior segment and surgical exposure of both maxillary permanent canines with subsequent orthodontic traction in order to move the impacted canines to their normal anatomic positions.Keywords: Odontoma, impacted maxillary canine, orthodontic traction ResumeUn cas de canines permanentes maxillaires impactees bilateralement avec odontome compose maxillaire gauche associe avec gonflement de l’os cortical obstruant le chemin d’eruption de la canine maxillaire permanente gauche et retention de la canine primaire sur le segment anterieur maxillaire droit. La prise en charge etait par extraction de la canine primaire maxillaire droite, excision chirurgicale de l’odontome compose sur le segment anterieur maxillaire gauche et exposition chirurgicale des deux canines permanentes maxillaires avec traction orthodontique ulterieure afin de deplacer les canines incluses dans leurs positions anatomiques normales.Mots cles: Odontome, canine maxillaire incluse, traction orthodontiqueCorrespondence: Dr. O.T. Temisanren, Department of Child Oral Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. oyetemisanren@yahoo.com
Background/ Objective: The aim of the study was to assess the effect of lockdown measures occasioned by COVID-19 pandemic on the physical and psychological characteristics of Nigerian athletes. Methods: An online survey involving 578 elite athletes was utilized, using an electronic questionnaire which sought information on respondents’ socio-demographics, sports type, level of psychological distress, injury incidences management, and expectations or otherwise of financial support during the lockdown period. Data obtained were analyzed with descriptive and inferential statistics with SPSS version 21 with alpha set at <0.05. Results: Results showed that the COVID-19 lockdown had a significant negative impact on respondents’ ratings of cardiovascular endurance, muscular strength, joint flexibility, speed, agility, coordination level and body weight. The Kessler Psychological Distress Scale showed that 44.1% of the respondents were likely to have been psychologically well, while 20.6% and 12.5% were likely to be having mild and moderate disorders respectively. 22.8% of the respondents were likely to be having severe disorder as a result of the lockdown restrictions. Results also showed no association between respondents’ age, gender, marital status, sports type and level of psychological distress. However, there were associations between the presence of injury and lack of access to its management during the lockdown period, expectation of financial support or palliative from club during lockdown period and the level of psychological distress. Conclusion: It was concluded that COVID-19 pandemic elicited reduction in physical attributes and varying levels of psychological distress among Nigerian athletes. Keywords: Coronavirus disease, lockdown restrictions, Nigerian athletes, physical characteristics, psychological distress ResumeContexte / Objectif: Le but de l’etude etait d’evaluer l’effet des mesures de verrouillage occasionnees par la pandemie de Covid-19 sur les caracteristiques physiques et psychologiques des athletes nigerians. Methodes: Une enquete en ligne portant sur 578 athletes d’elite a ete utilisee, a l’aide d’un questionnaire electronique qui cherchait des informations sur les caracteristiques sociodemographiques des repondants, le type de sport, le niveau de detresse psychologique, la gestion des incidences de blessures et les attentes ou non de soutien financier pendant la periode de verrouillage. Les donnees obtenues ont ete analysees avec des statistiques descriptives et inferentielles avec SPSS version 21 avec alpha fixe a d” 0,05. Resultats: Les resultats ont montre que le verrouillage du COVID-19 avait un impact negatif significatif sur les evaluations des repondants concernant l’endurance cardiovasculaire, la force musculaire, la flexibilite articulaire, la vitesse, l’agilite, le niveau de coordination et le poids corporel. L’echelle de detresse psychologique de Kessler a montre que 44,1% des repondants etaient susceptibles d’avoir ete psychologiquement bien, tandis que 20,6% et 12,5% etaient susceptibles d’avoir des troubles legers et moderes respectivement. 22,8% des repondants etaient susceptibles de souffrir de troubles graves en raison des restrictions de verrouillage. Les resultats n’ont egalement montre aucune association entre l’âge, le sexe, l’etat matrimonial, le type de sport et le niveau de detresse psychologique des repondants. Cependant, il y avait des associations entre la presence d’une blessure et le manque d’acces a sa gestion pendant la periode de verrouillage, l’attente d’un soutien financier ou palliatif du club pendant la periode de verrouillage et le niveau de detresse psychologique. Conclusion: Il a ete conclu que la pandemie de COVID-19 a entraine une reduction des attributs physiques et des niveaux variables de detresse psychologique chez les athletes nigerians.Mots cles: maladie a coronavirus, restrictions de verrouillage, athletes nigerians, caracteristiques physiques, detresse psychologique Correspondence: O.O. Ogundiran, Department of Physiotherapy, Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa, Nigeria. E-mail: femi_diran@yahoo.co
Department of Community Medicine1, Babcock University Teaching Hospital, Ilishan-Remo, and Department of Community Medicine and Primary Care2, Federal Medical Centre, Abeokuta, Ogun State, NigeriaAbstractBackground: Tuberculosis (TB) remains a high burden disease particularly in developing countries. The periodic appraisal of the outcome of treatment and associated determinants is of utmost value, as it serves as a litmus test of the impact of the TB control programme in the facility and its catchment area. This study thus aimed to review treatment outcomes and associated factors among drug sensitive pulmonary TB patients accessing care in a private tertiary hospital in Ogun State, Nigeria.Methods: A retrospective review of 171 drug sensitive pulmonary TB patients managed from January 2013 to December 2020 at the TB (DOTS) clinic of Babcock University Teaching Hospital (BUTH) was done. The socio-demographic, clinical, and laboratory data were extracted from the presumptive TB register. The analysis was done using SPSS version 20. Relevant descriptive and inferential statistics were calculated with the level of significance set at p< 0.05.Results: The mean age of the drug sensitive pulmonary TB patients was 42.11±14.86 years. More than half (51.5%) of them were females, while 48.5% were males. About two-fifth (38.6%) of the patients were classified as completed treatment, 35.7% achieved cure, 7.0% were lost to follow up, 0.6% had treatment failure and 18.1% died. Overall, 75.4% of the patients had treatment success while 24.6% had unsuccessful treatment. Those who were HIV negative had a statistically significantly better treatment outcome as compared to those who were HIV positive (p=0.03). There was also a statistically significant association between usage of HAART and treatment outcomes (p=0.002).Conclusion: The findings on better TB treatment outcomes among HIV negative patients and HIV positive patients on HAART highlight the need for HIV prevention strategies and sustainable provision of HAART during the management of TB.Keywords: BUTH, HAART, HIV, Ogun State, Treatment Outcome, TB.ResumeContexte: La tuberculose (TB) reste une maladie a charge elevee, en particulier dans les pays en developpement. L’evaluation periodique des resultats du traitement et des determinants associes est de la plus haute valeur, car elle sert de test decisif de l’impact du programme de lutte antituberculeuse dans l’etablissement et sa zone de desserte. Cette etude visait donc a examiner les resultats du traitement et les facteurs associes chez les patients atteints de tuberculose pulmonaire sensible aux medicaments accedant aux soins dans un hopital tertiaire prive de l’Etat d’Ogun, au Nigeria.Methodes: Une revue retrospective de 171 patients atteints de tuberculose pulmonaire sensible aux medicaments pris en charge de janvier 2013 a decembre 2020 a la clinique TB (DOTS) du Babcock University Teaching Hospital (BUTH) a ete realisee. Les donnees sociodemographiques, cliniques et de laboratoire ont ete extraites du registre presomptif de la tuberculose. L’analyse a ete effectuee a l’aide de la version 20 de SPSS. Les statistiques descriptives et inferentielles pertinentes ont ete calculees avec le niveau de signification fixe a p <0,05.Resultats: L’âge moyen des patients tuberculeux pulmonaires sensibles aux medicaments etait de 42,11 ± 14,86 ans. Plus de la moitie (51,5%) d’entre eux etaient des femmes, tandis que 48,5% etaient des hommes. Environ deux cinquiemes (38,6%) des patients ont ete classes comme traitement termine, 35,7% ont gueri, 7,0% ont ete perdus de vue, 0,6% ont echoue au traitement et 18,1% sont decedes. Dans l’ensemble, 75,4% des patients ont eu un succes de traitement tandis que 24,6% ont eu un traitement infructueux. Ceux qui etaient seronegatifs avaient des resultats de traitement statistiquement significativement meilleurs que ceux qui etaient seropositifs (p = 0,03). Il y avait egalement une association statistiquement significative entre l’utilisation du HAART et les resultats du traitement (p = 0,002).Conclusion: Les resultats sur de meilleurs resultats du traitement de la tuberculose chez les patients seronegatifs et les patients seropositifs sous HAART soulignent la necessite de strategies de prevention du VIH et de fourniture durable de HAART pendant la prise en charge de la tuberculose.Mots cles: BUTH, HAART, VIH, etat d’Ogun, resultat du traitement, tuberculose.Correspondence: Dr. K.O. Ogunyemi, Department of Community Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria. E-mail: ogunyemik@babcock.edu.n
Background: Postpartum haemorrhage (PPH) remains a leading contributory factor to maternal morbidity and mortality especially among women undergoing caesarean deliveries. Despite concerted efforts being made towards prevention, recurrent limiting factors in low-resource settings warrant the adoption of mechanisms that would further assist in combating the scourge. This study reviewed the outcome of intra-operative uterine packing of bleeding uteri in limiting blood loss from PPH. Methods: We reviewed the hospital records of patients who had postpartum haemorrhage over a period of five months retrospectively and present the outcome of 17 consecutive cases which were managed with intrauterine packing with abdominal mop as an adjunct measure. Structured proforma was used to obtain information on age, parity, socioeconomic status, mode of delivery, indications for surgery and history of intrauterine packing from the hospital records while data analysis was done using the statistical package for social sciences, SPSS, version 23.0. Results: Most common cause of intraoperative PPH was uterine atony, 13 (76.5%), and the mean blood loss was 1841.2±1165.4mL. Mean duration of intrauterine packing was 36.7±15.0 hours and average number of days on admission was 4.0±2.5.An average of 2 abdominal mops was used per packing and most procedures were performed by the medical officers (10, 58.8%). Overall, there was no case of maternal mortality among the patients managed and no abnormality was detected on follow up at 6 weeks. Conclusion: Uterine gauze packing is effective in reducing blood loss from intra-operative PPH in low resourcesettings. It, therefore, deserves a re-consideration as an addition to the armamentarium of available resources for reducing mortalities from PPH in developing countries. Keywords: Atony, Caesarean delivery, intrauterine packing, Postpartum Haemorrhage. ResumeContexte: L’hemorragie du post-partum (HPP) reste l’un des principaux facteurs contribuant a la morbidite et a la mortalite maternelles, en particulier chez les femmes qui accouchent par cesarienne. Malgre des efforts concertes de prevention, les facteurs limitatifs recurrents dans les pays a faibles ressources justifient l’adoption de mecanismes qui contribueraient davantage a lutter contre le fleau. Cette etude a examine les resultats de la compression uterine peroperatoire des saignements uterins en limitant la perte de sang due a l’HPP. Methodes: Nous avons revu retrospectivement les dossiers hospitaliers des patientes ayant eu une hemorragie postpartum sur une periode de cinq mois et presentons le resultat de 17 cas consecutifs qui ont ete geres avec un emballage intra-uterin avec une vadrouille abdominale comme mesure d’appoint. Un formulaire structure a ete utilise pour obtenir des informations sur l’âge, la parite, le statut socio-economique, le mode d’accouchement, les indications pour la chirurgie et les antecedents d’emballage intra-uterin a partir des dossiers de l’hopital, tandis que l’analyse des donnees a ete effectuee a l’aide du progiciel statistique pour les sciences sociales, SPSS, version 23.0. Resultats: La cause la plus frequente d’HPP peroperatoire etait l’atonie uterine, 13 (76,5%), et la perte sanguine moyenne etait de 1841,2 ± 1165,4 ml. La duree moyenne de l’emballage intra-uterin etait de 36,7 ± 15,0 heures et le nombre moyen de jours d’admission etait de 4,0 ± 2,5. Une moyenne de 2 vadrouilles abdominales a ete utilisee par emballage et la plupart des interventions ont ete effectuees par les medecins (10, 58,8%). Dans l’ensemble, il n’y a pas eu de cas de mortalite maternelle parmi les patientes prises en charge et aucune anomalie n’a ete detectee au suivi a 6 semaines. Conclusion: L’emballage de gaze uterine est efficace pour reduire la perte de sang due a l’HPP peroperatoire dans les milieux a faibles ressources. Il merite donc d’etre reexamine comme un ajout a l’arsenal de ressources disponibles pour reduire les mortalites dues a l’HPP dans les pays en developpement. Mots cles: Atony, accouchement par cesarienne, emballage intra-uterin, hemorragie post-partum. Correspondence: Dr. T.A.O. Oluwasola, Department of Obstetrics and Gynaecology, University College Hospital, Ibadan and College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: sesanoluwasola@yahoo.com
Background: Resistance of uropathogens to conventional antibiotics is increasing, thus creating the need to search for newer and effective antimicrobial agents to treat urinary tract infections (UTI). Methods: The susceptibility pattern of twenty clinical isolates of uropathogenic bacteria to standard antibiotics and extracts of Dalbergia latifolia was investigated using Agar Disc and Agar Well Diffusion methods, respectively. Minimum Inhibitory Concentrations (MICs) of the extracts were determined by Agar Dilution method on some of the uropathogens. Results: All the test pathogens were resistant to Amoxicillin, Cotrimoxazole and Augmentin. The isolates had 25 % (4), 12.5% (2), 18.75% (3), 68.75% (11) susceptibility to Nitrofurantoin, Gentamicin, Nalidixic acid and Ofloxacin respectively while 87.5% showed resistant to Tetracycline. The E. coli and K. pneumoniae strains had the highest susceptibility to Ofloxacin while P. mirabilis 4 was susceptible to Ofloxacin. The uropathogenic S. aureus was highly resistant to the antibiotics, however S. aureus 3 and S. aureus 4 were susceptible to gentamicin while S. aureus 1 and S. aureus 5 were susceptible to chloramphenicol. Gentamicin and chloramphenicol were the most active on S. aureus. The extracts showed good activity on most of the uropathogens in which 81.81 % (18), 9.0% (2) and 63.63% (14) of the test pathogens were susceptible to the leaf, stem and root (successively) of D. latifolia. The MIC values of extracts on test organisms ranged from 0.063 to 2.0 mg/mL. Conclusion: The results revealed varied patterns of susceptibility of the uropathogens to conventional antibiotics, necessitating rational use of antibiotic in routine treatment of UTI to prevent development of resistance. Further, activity of D. latifolia extracts on the uropathogens justified its folkloric use and underlined the potentials of the plant to furnish antimicrobial agents for the treatment of UTIs, including those resistant to conventional antibiotics. Keywords: Uropathogens, antibiotics, resistance, Dalbergia latifolia extracts, MICs Resume Contexte: La resistance des uropathogenes aux antibiotiques conventionnels augmente, creant ainsi le besoin de rechercher des agents antimicrobiens plus recents et efficaces pour traiter les infections des voies urinaires (IVU). Methodes: Le profil de sensibilite de vingt isolats cliniques de bacteries uropathogenes aux antibiotiques standard et aux extraits de Dalbergia latifolia a ete etudie en utilisant les methodes Agar Disc et Agar Well Diffusion, respectivement. Les concentrations minimales inhibitrices (CMI) des extraits ont ete determinees par la methode de dilution d’agar sur certains des uropathogenes. Resultats: Tous les pathogenes testes etaient resistants a l’amoxicilline, au cotrimoxazole et a l’augmentation. Les isolats presentaient respectivement une sensibilite de 25% (4), 12,5% (2), 18,75% (3), 68,75% (11) a la nitrofurantoine, a la gentamicine, a l’acide nalidixique et a l’ofloxacine, tandis que 87,5% etaient resistants a la tetracycline. Les souches d’E. Coli et de K. pneumoniae etaient les plus sensibles a l’ofloxacine, tandis que P. mirabilis 4 etait sensible a l’ofloxacine. Le S. aureus uropathogene etait tres resistant aux antibiotiques, cependant S. aureus 3 et S. aureus 4 etaient sensibles a la gentamicine tandis que S. aureus 1 et S. aureus 5 etaient sensibles au chloramphenicol. La gentamicine et le chloramphenicol etaient les plus actifs sur S. aureus. Les extraits ont montre une bonne activite sur la plupart des uropathogenes dans lesquels 81,81% (18), 9,0% (2) et 63,63% (14) des pathogenes testes etaient sensibles aux feuilles, aux tiges et aux racines (successivement) de D. latifolia. Les valeurs de CMI des extraits sur les organismes d’essai variaient de 0,063 a 2,0 mg / mL. Conclusion: Les resultats ont revele des schemas varies de sensibilite des uropathogenes aux antibiotiques conventionnels, necessitant l’utilisation rationnelle de l’antibiotique dans le traitement de routine des infections urinaires pour empecher le Summary Background: Resistance of uropathogens to conventional antibiotics is increasing, thus creating the need to search for newer and effective antimicrobial agents to treat urinary tract infections (UTI). Methods: The susceptibility pattern of twenty clinical isolates of uropathogenic bacteria to standard antibiotics and extracts of Dalbergia latifolia was investigated using Agar Disc and Agar Well Diffusion methods, respectively. Minimum Inhibitory Concentrations (MICs) of the extracts were determined by Agar Dilution method on some of the uropathogens. Results: All the test pathogens were resistant to Amoxicillin, Cotrimoxazole and Augmentin. The isolates had 25 % (4), 12.5% (2), 18.75% (3), 68.75% (11) susceptibility to Nitrofurantoin, Gentamicin, Nalidixic acid and Ofloxacin respectively while 87.5% showed resistant to Tetracycline. The E. coli and K. pneumoniae strains had the highest susceptibility to Ofloxacin while P. mirabilis 4 was susceptible to Ofloxacin. The uropathogenic S. aureus was highly resistant to the antibiotics, however S. aureus 3 and S. aureus 4 were susceptible to gentamicin while S. aureus 1 and S. aureus 5 were susceptible to chloramphenicol. Gentamicin and chloramphenicol were the most active on S. aureus. The extracts showed good activity on most of the uropathogens in which 81.81 % (18), 9.0% (2) and 63.63% (14) of the test pathogens were susceptible to the leaf, stem and root (successively) of D. latifolia. The MIC values of extracts on test organisms ranged from 0.063 to 2.0 mg/mL. Conclusion: The results revealed varied patterns of susceptibility of the uropathogens to conventional antibiotics, necessitating rational use of antibiotic in routine treatment of UTI to prevent development of resistance. Further, activity of D. latifolia extracts on the uropathogens justified its folkloric use and underlined the potentials of the plant to furnish antimicrobial agents for the treatment of UTIs, including those resistant to conventional antibiotics. Keywords: Uropathogens, antibiotics, resistance, Dalbergia latifolia extracts, MICs Resume Contexte: La resistance des uropathogenes aux antibiotiques conventionnels augmente, creant ainsi le besoin de rechercher des agents antimicrobiens plus recents et efficaces pour traiter les infections des voies urinaires (IVU). Methodes: Le profil de sensibilite de vingt isolats cliniques de bacteries uropathogenes aux antibiotiques standard et aux extraits de Dalbergia latifolia a ete etudie en utilisant les methodes Agar Disc et Agar Well Diffusion, respectivement. Les concentrations minimales inhibitrices (CMI) des extraits ont ete determinees par la methode de dilution d’agar sur certains des uropathogenes.Resultats: Tous les pathogenes testes etaient resistants a l’amoxicilline, au cotrimoxazole et a l’augmentation. Les isolats presentaient respectivement une sensibilite de 25% (4), 12,5% (2), 18,75% (3), 68,75% (11) a la nitrofurantoine, a la gentamicine, a l’acide nalidixique et a l’ofloxacine, tandis que 87,5% etaient resistants a la tetracycline. Les souches d’E. Coli et de K. pneumoniae etaient les plus sensibles a l’ofloxacine, tandis que P. mirabilis 4 etait sensible a l’ofloxacine. Le S. aureus uropathogene etait tres resistant aux antibiotiques, cependant S. aureus 3 et S. aureus 4 etaient sensibles a la gentamicine tandis que S. aureus 1 et S. aureus 5 etaient sensibles au chloramphenicol. La gentamicine et le chloramphenicol etaient les plus actifs sur S. aureus. Les extraits ont montre une bonne activite sur la plupart des uropathogenes dans lesquels 81,81% (18), 9,0% (2) et 63,63% (14) des pathogenes testes etaient sensibles aux feuilles, aux tiges et aux racines (successivement) de D. latifolia. Les valeurs de CMI des extraits sur les organismes d’essai variaient de 0,063 a 2,0 mg / mL. Conclusion: Les resultats ont revele des schemas varies de sensibilite des uropathogenes aux antibiotiques conventionnels, necessitant l’utilisation rationnelle de l’antibiotique dans le traitement de routine des infections urinaires pour empecher le developpement d’une resistance. En outre, l’activite des extraits de D. latifolia sur les uropathogenes justifiait son utilisation folklorique et soulignait le potentiel de la plante a fournir des agents antimicrobiens pour le traitement des infections urinaires, y compris celles resistantes aux antibiotiques conventionnels. Mots cles: Uropathogenes, antibiotiques, resistance, extraits de Dalbergia latifolia, CMI Correspondence: Dr. P.A Idowu, Department of Pharmaceutical Microbiology, University of Ibadan, Ibadan, Nigeria. Email:igboyega@yahoo.com
Background: Sickle cell disease (SCD) is a heterogenous group of inherited haemoglobin disorder characterized by inheritance of β s gene and another β s gene (homozygous sickle cell anaemia -SCA) or haemoglobin S gene (HbSC), haemoglobin D or haemoglobin E gene.. SCA is the commonest type accounting for about 70% of SCD worldwide. Nigeria has the highest burden worldwide with an estimated 150,000 SCD births annually out of the estimated 275,000 annual global births. SCD patients presents with acute painful, haemolytic and sequestration crises, acute chest syndrome, and stroke. Aims/Objectives: To describe the pattern of presentation and treatment modalities offered SCD patients in the setting of a University health centre. Materials and method: A descriptive cross sectional study was conducted at the University of Ibadan Health Centre among SCD patients who presented over a five-year period. Data was extracted from the case folders and analyzed using SPSS version 23. Results: Seventy-eight SCD patients were documented to have utilized the health centre in the period under review. The median age was 24 years (IQR: 16, 52). The male to female ratio was 1.3: 1. Homozygous HbSS constituted 64(82%) while 14(18%) were HbSC. All the patients had presented to the clinic on account of bone pain crisis and a few 12(15%) presented with symptoms of haemolytic crises. The commonest used analgesics were NSAIDS 54(74%), dihydrocodeine 43(54%)) and pentacozine 43 (54%). Conclusion: Sickle cell disease is a life- long disease where cure is not readily attained hence the recommendation of early intervention of expert to ensure proper management of acute complications of the disease. There is a need to continue to train General practitioners on current management principles and guidelines in care of SCD patients. Keywords: Sickle cell disease, presentation pattern, analgesic usage, University Health Centre, Ibadan. ResumeContexte: La drepanocytose (SCD) est un groupe heterogene de trouble hereditaire de l’hemoglobine caracterise par l’heredite du gene âs et d’un autre gene âs (drepanocytose homozygote -SCA) ou du gene de l’hemoglobine C (HbSC), de l’hemoglobine D ou du gene de l’hemoglobine E. Le SCA est le type le plus courant representant environ 70% des SCD dans le monde. Le Nigeria a le fardeau le plus eleve au monde avec environ 150 000 naissances de drepanocytose par an sur les 275 000 naissances annuelles dans le monde. Les patients SCD presentent des crises douloureuses aigues, hemolytiques et de sequestration, un syndrome thoracique aigu et un accident vasculaire cerebral.Buts / Objectifs: Decrire le modele de presentations et les modalites de traitement offertes aux patients atteints de drepanocytose dans le cadre d’un centre de sante universitaire. Materiel et methode: Une etude transversale descriptive a ete menee au centre de sante de l’Universite d’Ibadan parmi des patients atteints de drepanocytose qui se sont presentes sur une periode de cinq ans. Les donnees ont ete extraites des dossiers de cas et analysees a l’aide de la version 23 de SPSS. Resultats: Soixante-dix-huit patients atteints de drepanocytose ont ete documentes comme ayant utilise la clinique du centre de sante au cours de la periode consideree. L’âge median etait de 24 ans (IQR: 16, 52). Le ratio homme / femme etait de 1,3: 1. L’HbSS homozygote constituait 64 (82%) tandis que 14 (18%) etaient l’HbSC. Tous les patients s’etaient presentes a la clinique pour crise de douleur osseuse et quelques 12 (15%) presentaient des symptomes de crise hemolytique. Les analgesiques les plus couramment utilises etaient les AINS 54 (74%), la dihydrocodeine 43 (54%)) et la pentacozine 43 (54%). Conclusion: La drepanocytose est une maladie a vie ou la guerison n’est pas facilement obtenue, d’ou la recommandation d’une intervention precoce d’un expert pour assurer une prise en charge adequate des complications aigues de la maladie. Il est necessaire de continuer a former les medecins generalistes sur les principes de prise en charge actuels et les lignes directrices en matiere de soins des patients atteints de drepanocytose. Mots cles: drepanocytose, schema de presentation, usage analgesique, centre de sante universitaire, Ibadan. Corespondence: Dr S. P. Ogundeji, Department of Haematology, College of Medicine, University of Ibadan, Ibadan Nigeria. E-mail: peterogundeji22@gmail.com
Background: Head and neck cancers (HNC) constitute a diverse group of diseases including malignancies of the oral cavity, oropharynx, larynx, si nuses, and skull base. They constitute 5-50% of all cancers globally and 6.2% of all cancers in Nigeria. Majority of these patients usually present with advanced staged disease and they are mostly for palliative care. Methodology: Data for this study was retrieved from case files of patients seen at Hospice and Palliative care unit, UCH, Ibadan from February 2008 - January 2018. Their bio data, diagnosis and services offered were extracted and analyzed. Results: There was a total of 77 patients with Head and Neck Cancers seen; 38 males and 39 females (M/F=1:1) out of a total of 1,765 patients enrolled by the Unit during the study period. Of these 77 patients, 20(26%) lived within the department’s catchment area for Home based care services. Services rendered included pain control, home based care, patient counseling, financial support, phone calls, psychosocial support, day care forum and bereavement support. Patient counseling was offered to all patients and pain control was managed with analgesics using the World Health Organization analgesic ladder. Other symptoms managed were sore throat, weight loss, headache, drowsiness, odynophagia. At the end of the period under review 50 (65%) were dead and 26 (34%) of the patients were lost to follow up and 1 (1%) of the patients is alive. Conclusion: Patients with Head and Neck Cancers had supportive services rendered for their pain, other symptoms control and their psychosocial issues. Palliative care should be made available and accessible to all patients who require it. Keywords: Head, neck, cancer, malignancies, oropharynx, sinuses ResumeContexte: Les cancers de la tete et du cou (HNC) constituent un groupe diversifie de maladies, y compris les tumeurs malignes de la cavite buccale, de l’oropharynx, du larynx, des sinus et de la base du crâne. Ils constituent 5 a 50% de tous les cancers dans le monde et 6,2% de tous les cancers au Nigeria. La majorite de ces patients presentent generalement une maladie a un stade avance et ils sont principalement destines aux soins palliatifs. Methodologie: Les donnees de cette etude ont ete extraites des dossiers de cas de patients vus a l’unite de soins palliatifs et palliatifs, UCH, Ibadan de fevrier 2008 a janvier 2018. Leurs donnees biologiques, le diagnostic et les services offerts ont ete extraits et analyses. Resultats: Au total, 77 patients atteints de cancers de la tete et du cou ont ete vus; 38 hommes et 39 femmes (H / F = 1: 1.) Sur un total de 1 765 patients recrutes par l’Unite au cours de la periode d’etude. Sur ces 77 patients, 20 (26%) vivaient dans la zone de desserte du departement pour les services de soins a domicile. Les services rendus comprenaient le controle de la douleur, les soins a domicile, les conseils aux patients, le soutien financier, les appels telephoniques, le soutien psychosocial, le forum de garde de jour et le soutien au deuil. Des conseils aux patients ont ete proposes a tous les patients et le controle de la douleur a ete gere avec des analgesiques en utilisant l’echelle analgesique de l’Organisation mondiale de la sante. Les autres symptomes pris en charge etaient les maux de gorge, la perte de poids, les maux de tete, la somnolence, l’odynophagie. A la fin de la periode sous revue, le nombre (65%) etaient decedes et le nombre (34%) des patients ont ete perdus de vue et le nombre (1%) des patients est en vie. Conclusion: Les patients atteints de cancers de la tete et du cou ont beneficie de services de soutien concernant leur douleur, le controle des autres symptomes et leurs problemes psychosociaux. Les soins palliatifs doivent etre disponibles et accessibles a tous les patients qui en ont besoin. Mots cles: Tete et cou, oropharynx, larynx, sinus Correspondence: Mrs. O.A Maboreje, Hospice and Palliative Care Department, University College Hospital, Ibadan, Nigeria
Background: Infertility is a universal health burden with profound consequences in low/middle-income countries (LMIC). The global prevalence of infertility is between 8-12 % with values as high as 32 % in Central and Southern Africa, often referred to as the “infertility belt” [1]. In Nigeria, a prevalence rate of between 20-30% has been estimated due to the high prevalence of sexually transmitted infections [2]. The consequences of involuntary childlessness in a low/middle-income country can be devastating, leading to economic deprivation and impoverishing medical costs [3]. There is a high premium placed on childbearing in developing countries due to the socio-cultural beliefs and practices, yet there exists a high disparity between urban and rural dwellers with respect to accessing health care [4]. Challenge(s): There is an unmet need for assisted conception in sub-Saharan Africa as published data suggest less than 1.5% of the African population have access to assisted conception services [3]. This is further compounded by the high tubal factor infertility requiring in-vitro fertilization. Assisted conception requires significant investment in manpower and infrastructure, the cost of which is borne by the patients seeking care. Invariably, assisted conception is strenuous, time consuming, expensive, and often inaccessible to the financially vulnerable. Out-of- pocket payment for services is a major limiting factor in developing countries as insurance coverage and government support are lacking. In the absence of financial protection, out-of-pocket payments can ultimately lead to household poverty [5]. Opportunities: Expanding access to Assisted Reproductive Technology in developing countries will alleviate the impact of infertility which has been declared an issue of Public Health importance by the World Health Organization [6]. Embracing low-cost treatment protocols and partnerships via the hub-and-spoke organization design with relevant stakeholders may be the panacea in developing countries, as resources are far from equitable. Conclusion: A paradigm shifts by government towards prioritizing infertility management against the background of a delicate balance between overpopulation and paucity of resources will provide succor to the financially vulnerable and often forgotten infertile couples. Keywords: Access, Assisted Reproductive Technology, Developing Country. ResumeContexte: L’infertilite est un fardeau de sante universel avec des consequences profondes dans les pays a revenu faible ou intermediaire (PRFI). La prevalence mondiale de l’infertilite se situe entre 8 et 12% avec des valeurs aussi elevees que 32% en Afrique centrale et australe, souvent appelee «ceinture d’infertilite» [1]. Au Nigeria, un taux de prevalence compris entre 20 et 30% a ete estime en raison de la forte prevalence des infections sexuellement transmissibles [2]. Les consequences de l’absence d’enfant involontaire dans un pays a revenu faible ou intermediaire peuvent etre devastatrices, entrainant une privation economique et une diminution des frais medicaux [3]. Les croyances et pratiques socioculturelles accordent une grande importance a la procreation dans les pays en developpement, mais il existe une forte disparite entre les citadins et les ruraux en ce qui concerne l’acces aux soins de sante [4]. Defi (s): Il existe un besoin non satisfait de procreation assistee en Afrique subsaharienne car les donnees publiees suggerent que moins de 1,5% de la population africaine a acces a des services de procreation assistee [3]. Ceci est encore aggrave par l’infertilite tubaire elevee necessitant une fecondation in vitro. La conception assistee necessite un investissement important en main-d’œuvre et en infrastructure, dont le cout est supporte par les patients qui recherchent des soins. Invariablement, la conception assistee est ardue, longue, couteuse et souvent inaccessible aux personnes financierement vulnerables. Le paiement direct des services est un facteur limitant majeur dans les pays en developpement, car la couverture d’assurance et le soutien gouvernemental font defaut. En l’absence de protection financiere, les paiements directs peuvent en fin de compte conduire a la pauvrete des menages [5].Opportunites: L’elargissement de l’acces aux technologies de procreation assistee dans les pays en developpement attenuera l’impact de l’infertilite, qui a ete declaree probleme de sante publique par l’Organisation mondiale de la sante [6]. Adopter des protocoles de traitement a faible cout et des partenariats via la conception d’organisation en etoile avec les parties prenantes concernees peut etre la panacee dans les pays en developpement, car les ressources sont loin d’etre equitables. Conclusion: Un changement de paradigme du gouvernement vers la priorite a la gestion de l’infertilite dans le contexte d’un equilibre delicat entre la surpopulation et la rarete des ressources apportera une aide aux couples infertiles financierement vulnerables et souvent oublies. Mots cles: Acces, technologie de procreation assistee, pays en developpement. Correspondence: Dr G.O. Obajimi, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: gbolahanobajimi@gmail.com
Department of Ophthalmology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.AbstractBackground: The use of anti-vascular endothelial growth factor (anti-VEGF) agents has increased in recent years. This is because of the increasing detection of vitreo-retinal disorders associated with vascular abnormalities. The indications vary from one location to another. Visual outcome following treatment with these agents also vary with disease severity and promptness of intervention.Methodology: A prospective observational study was carried out on all patients with retinal disorders who had intravitreal injection between November 2013 and November 2019. Data on demographic characteristics, presenting visual acuity, diagnosis, type of anti-VEGF agent used, post-treatment visual acuity and complications were retrieved and entered into Statistical Package for Social Sciences (SPSS) version 25 and analysed for frequency and proportions.Results: Seven hundred and thirty two patients with retinal pathologies were seen during the study period. A total of 251 intravitreal anti-VEGF agent injections were administered to 95 patients during the period under review. The mean age of the patients was 64.3 ±12.7 years. The number of injections per eye varied from 2 to 6 with an average of 2.6 per eye. Bevacizumab was the more commonly utilized anti-VEGF medication as it was used for 231(92%) injections. Wet age-related maculopathy was the commonest indication for intravitreal anti-VEGF agent in 61(24.3%) followed by diabetic macula edema in 55(21.9%) and retinal vein occlusion with macular edema in 54(21.5%) injections. Visual improvement was observed in 69 (72.6%) patients.Conclusion: Anti-VEGF therapy was useful in the management of patients with retinal disorders. The need for multiple injections and the attendant cost still constitutes a major challenge in the use of these medications. Keywords: Intravitreal, Retina, Bevacizumab, Ranibizumab, Retina disorders, Antivascular endothelial growth factor agents.Resume Contexte: L’utilisation d’agents anti-facteur de croissance endothelial vasculaire (anti-VEGF) a augmente ces dernieres annees. Ceci est du a la detection croissante des troubles vitreo-retiniens associes auxanomalies. Les indications varient d’un endroit a l’autre. Le resultat visuel apres le traitement avec ces agents varie egalement en fonction de la gravite de la maladie et de la rapidite de l’intervention.Methodologie: Une etude observationnelle prospective a ete menee sur tous les patients atteints de retinetroubles ayant subi une injection intravitreenne entre novembre 2013 et novembre 2019. Donnees sur les caracteristiques demographiques, presentant l’acuite visuelle, le diagnostic, le type de agent anti-VEGF utilise, l’acuite visuelle post-traitement et les complications ont ete recuperees et entre dans le progiciel statistique pour les sciences sociales (SPSS) version 25 et analyse pour frequence et proportions.Resultats: Sept cent trente-deux patients atteints de pathologies retiniennes ont ete vus au cours de la periode d’etude. Au total, 251 injections d’agent anti-VEGF intravitreen ont ete administrees a 95 patients au cours de la periode sous revue. L’âge moyen des patients etait de 64,3 ± 12,7 ans. Le nombre d’injections par œil variait de 2 a 6 avec une moyenne de 2,6 par œil. Le bevacizumab etait le medicament anti-VEGF le plus couramment utilise car il etait utilise pour 231 injections (92%). La maculopathie humide liee a l’âge etait l’indication la plus courante de l’anti-VEGF intravitreen chez 61 (24,3%), suivie de l’œdeme diabetique de la macula dans 55 (21,9%) et de l’occlusion veineuse retinienne avec œdeme maculaire dans 54 (21,5%) injections. Une amelioration visuelle a ete observee chez 69 patients (72,6%).Conclusion: La therapie anti-VEGF a ete utile dans la prise en charge des patients atteints de troubles retiniens. La necessite de multiples injections et le cout associe constituent toujours un defi majeur dans l’utilisation de ces medicaments.Mots cles: Intravitreen, Retine, Bevacizumab, Ranibizumab, Troubles de la retine, Agents de facteur de croissance endothelial anti-vasculaire.Correspondence: Dr. I.A. Ajayi, Department of Ophthalmology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. E-mail:iyiseye2005@gmail.com
Background: Advanced cancer of the prostate often causes pain that can be severe requiring palliation with analgesics. Zoledronic acid, a third-generation bisphosphonate, has not been primarily used as an adjunct to treat pain in patients with metastatic bone secondary to advanced prostate cancer in Nigeria. The study investigated the effects of 3 doses of Zoledronic acid, at 4-weekly intervals, in addition to the analgesic regimen of oral morphine, diclofenac, paracetamol and amitriptyline, on bone pain in patients with metastatic prostate cancer . Methods: A prospective randomized open-labelled trial in which forty patients with moderate to severe bone pain due to metastatic prostate cancer were recruited after institutional ethics approval. Patients were assigned to two groups: The Control (C) group received liquid oral morphine, diclofenac, paracetamol and amitriptyline. Zoledronic acid (ZG) group received 3 doses of Zoledronic acid at 4-weekly intervals in addition to liquid morphine, diclofenac, paracetamol and amitriptyline. Severity of pain and quality of life (QoL) were measured at baseline and weekly for 12 weeks. Data were analysed using means, range, standard deviations and proportions while independent t-test was used to compare the variables between the two groups. Results: Demographic variables, baseline pain scores and quality of life between the 2 groups were similar. Therewas a statistically significant improvement in pain score in the Zoledronic acid group (1.38±0.53 vs 2.13±0.94) post-intervention, (p = 0.004). Conclusion: The administration of three doses of Zoledronic acid at 4-weekly intervals significantly improved bone pain score during the 12-weeks follow up in patients with advanced prostate cancer. Keywords: Zoledronic acid, Bone pain, Prostate cancer. Resume Contexte: Le cancer avance de la prostate provoque souvent des douleurs qui peuvent etre severes necessitant des soins palliatifs avec des analgesiques. L’acide zoledronique, un bisphosphonate de troisieme generation, n’a pas ete principalement utilise comme adjuvant pour traiter la douleur chez les patients presentant des metastases osseuses secondaires a un cancer avance de la prostate au Nigeria. L’etude a examine les effets de 3 doses d’acide zoledronique, a des intervalles de 4 semaines, en plus du regime analgesique de morphine orale, de diclofenac, de paracetamol et d’amitriptyline, sur la douleur osseuse chez les patients atteints d’un cancer metastatique de la prostate. Methodes: Un essai prospectif randomise ouvert dans lequel quarante patients souffrant de douleurs osseuses moderees a severes dues a un cancer metastatique de la prostate ont ete recrutes apres approbation ethique de l’etablissement. Les patients ont ete repartis en deux groupes: Le groupe temoin (C) a recu de la morphine orale liquide, du diclofenac, du paracetamol et de l’amitriptyline. Le groupe acide zoledronique (ZG) a recu 3 doses d’acide zoledronique a intervalles de 4 semaines en plus de la morphine liquide, du diclofenac, du paracetamol et de l’amitriptyline. La severite de la douleur et la qualite de vie (QdV) ont ete mesurees au depart et chaque semaine pendant 12 semaines. Les donnees ont ete analysees a l’aide des moyennes, de la plage, des ecarts-types et des proportions, tandis qu’un test t independant a ete utilise pour comparer les variables entre les deux groupes. Resultats: Les variables demographiques, les scores de douleur de base et la qualite de vie entre les 2 groupes etaient similaires. Il y avait une amelioration statistiquement significative du score de douleur dans le groupe acide zoledronique (1,38 ± 0,53 vs 2,13 ± 0,94) apres l’intervention, (p = 0,004). Conclusion: L’administration de trois doses d’acide zoledronique a des intervalles de 4 semaines a significativement ameliore le score de douleur osseuse au cours des 12 semaines de suivi chez les patients atteints d’un cancer de la prostate avance. Mots cles: Acide zoledronique, douleur osseuse, cancer de la prostate. Correspondence: Dr. M.O . Akinwale, Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan. Nigeria E-mail: akinsmko@yahoo.com, moakinwale@com.ui.edu.ng
Introduction: Adansonia digitata L (baobab) is a forest tree, primarily in Africa and Asia. Fruit pulp extract of baobab possesses anti-inflammatory, hepatoprotective, anticlastogenic and other medicinal properties.This study evaluates the in vitro antioxidant and anticancer potentials of the aqueous extract of the fruit pulp of baobab and its fractions. Methods: Cold extraction was done on the pulp for 72 h. The extract was filtered and concentrated; and then resuspended in water and sonicated. The mixture was sequentially fractionated to obtain n-hexane fraction (NHF), chloroform fraction (CRF), ethyl acetate fraction (EAF), n-butanol fraction (NBF) and residual aqueous fraction (AQF).The DPPH, ABTS, nitrite scavenging capacity and reducing antioxidant power assays were determined spectrophotometrically. Anticancer activity on A-549, KB, T-24 and A-498 cell lines was evaluated using sulphurhodamin B assay. Results: The DPPH radical scavenging activity indicates that NBF has IC50 (43.44µg/mL) closest to that of the standard (Ascorbic acid) (27.22 µg/mL). For ABTS scavenging activity, NBF with IC50 value of 38.28µg/mL is closest to the standard (7.41µg/mL). For nitrite scavenging capacity, EAF has IC50 value (66.05µg/mL) closest to the standard (35.52µg/mL). Overall antioxidant results showed that NBF fraction has the highest antioxidant capacity of all the fractions. The various fractions were not significantly cytotoxic. However, morphological observation with phase contrast microscope showed that CRF, EAF and NBF induced cytotoxic effects on human oral cancer cells (KB). Conclusion: Aqueous extract of the fruit pulp of baobab and its fractions could be applied as natural sources of antioxidant and the fractions are cytotoxic on KB cells. Keywords: Adansonia digitata, Antioxidant activity, Cytotoxicity, anticancer activity, aqueous extract, sulphurhodamin B assay. ResumeContexte: Adansonia digitata L (baobab) est un arbre forestier, principalement en Afrique et en Asie. L’extrait de pulpe de fruit de baobab possede des proprietes anti-inflammatoires, hepatoprotectrices, anticlastogeniques et autres. Cette etude evalue les potentiels antioxydants et anticancereux in vitro de l’extrait aqueux de pulpe de fruit de baobab et de ses fractions. Methodes: Une extraction a froid a ete effectuee sur la pulpe pendant 72 h. L’extrait a ete filtre et concentre; puis remis en suspension dans l’eau et sonique. Le melange a ete fractionne sequentiellement pour obtenir une fraction de n-hexane (NHF), une fraction de chloroforme (CRF), une fraction d’acetate d’ethyle (EAF), une fraction de n-butanol (NBF) et une fraction aqueuse residuelle (AQF). Le DPPH, l’ABTS, la capacite de piegeage des nitrites et les dosages de pouvoir antioxydant reducteur ont ete determines par spectrophotometrie. L’activite anticancereuse sur la ligne des cellules A-549, KB, T-24 et A-498 a ete evaluee en utilisant un dosage de sulfurhodamine B. Resultats:L’activite de piegeage des radicaux DPPH indique que le NBF a une CI50 (43,44 µg / mL) plus proche de celle du standard (acide ascorbique) (27,22 µg / mL). Pour l’activite de piegeage ABTS, le NBF avec une valeur IC50 de 38,28 µg / mL est le plus proche de la norme (7,41 µg / mL). Pour la capacite de piegeage des nitrites, l’EAF a la valeur IC50 (66,05 µg / mL) la plus proche de la norme (35,52 µg / mL). Les resultats globaux des antioxydants ont montre que la fraction NBF a la capacite antioxydante la plus elevee de toutes les fractions. Les differentes fractions n’etaient pas significativement cytotoxiques. Cependant, l’observation morphologique au microscope a contraste de phase a montre que le CRF, l’EAF et le NBF induisaient des effets cytotoxiques sur les cellules cancereuses orales humaines (KB). Conclusion: L’extrait aqueux de pulpe de fruit de baobab et ses fractions pourrait etre applique comme source naturelle d’antioxydant et les fractions sont cytotoxiques sur les cellules KB. Mots cles: Adansonia digitata, activite antioxydante, cytotoxicite, activite anticancereuse, extrait aqueux, dosage de sulfurhodamineB. Correspondence: Prof. Oyeronke A. Odunola, Department of Biochemistry, College of Medicine, University of Ibadan, Ibadan. Nigeria. E-mail: ronodunola@yahoo.com and aygokea@gmail.com
Objective: The study examined factors associated with inconsistent condom use and multiple sexual partners among adolescents in Osun State. Methods: Descriptive cross-sectional study of 450 adolescents interviewed using a pre-tested, semi-structured questionnaire. Focus group discussions (FGDs) were conducted among this in-school and out-of- school adolescents. Main outcomes were inconsistent condom use and multiple sexual partners within previous year. Qualitative data was used to triangulate findings from the quantitative data which was analyzed using SPSS version 16. Results: The mean age of respondents was 15 (SD 2.6) years. One hundred and thirty adolescents (28.9%) have had sexual intercourse and only 36 (27.7%) of these used condom consistently. Fifty-five respondents (42.3% of the sexually active) had multiple sexual partners in the last year. Most participants in FGD agreed that adolescents get involved in high-risk sexual practices secondary to peer pressure and lack of parental care. Pornography, male gender and castigation of chastity among peers were some of the factors significantly associated with multiple sexual partners (p < 0.05). Conclusion: Sexually active adolescents have low risk perception of condom use and have multiple sexual partners. Preventive education could increase their risk perception and reduce risk taking among this vulnerable group. Keywords: adolescents, inconsistent condom use, multiple sexual partner. AbstraitObjectif: L’etude a examine les facteurs associes a l’utilisation irreguliere du preservatif et aux partenaires sexuels multiples parmi les adolescents de l’Etat d’Osun. Methodes: Une etude transversale descriptive de 450 adolescents interroges a l’aide d’un questionnaire semistructure pre-teste. Des discussions de groupe focus (DGF) ont ete organises parmi ces adolescents scolarises et non scolarises. Les principaux resultats etaient l’utilisation irreguliere du preservatif et la multiplicite des partenaires sexuels au cours de l’annee precedente. Des donnees qualitatives ont ete utilisees pour trianguler les resultats des donnees quantitatives qui ont ete analysees a l’aide de SPSS version 16. Resultats: L’âge moyen des repondants etait de 15 ans (ET 2,6). Cent trente adolescents (28,9%) ont eu des rapports sexuels et seulement 36 (27,7%) d’entre eux ont utilise le preservatif regulierement. Cinquante-cinq repondants (42,3% des sexuellement actifs) ont eu plusieurs partenaires sexuels au cours de la derniere annee. La plupart des participants aux discussions de groupe focus ont convenu que les adolescents s’impliquent dans des pratiques sexuelles a haut risque en raison de la pression des pairs et le manque de soins parentaux. La pornographie, le genre masculin et la fustigation de la chastete entre les pairs etaient quelquesuns des facteurs significativement associes aux partenaires sexuels multiples (p < 0,05). Conclusion: Les adolescents sexuellement actifs ont une faible perception du risque de l’utilisation du preservatif et ont de multiples partenaires sexuels. L’education preventive pourrait accroitre leur perception du risque et reduire la prise de risque au sein de ce groupe vulnerable. Mots cles: adolescents, utilisation irreguliere du preservatif, partenaire sexuel multiple. Correspondence: Dr. S.A. Olowookere, Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria. E-mail: sanuolowookere@yahoo.com.
Background:Conflicting findings from individual epidemiological studies do not allow for validassumptions about the true prevalenceof dementia in sub-Saharan Africa (SSA). We conducted asystematic review and meta-analysis of dementia studies in SSA to arrive at a pooled prevalence estimate and associated factors.Materials and methods:We searched Medline, EMBASE, PsychINFO, and African Journals Online usingindex medicus keywords for dementia and the .mp operator for all 54 SSA countries or regions. Furtherinformation was retrieved through a manual search of references from relevant articles. We included peerreviewed original studies with epidemiological or experimental designs, conducted random effect metaanalysis of prevalence estimates and determined associated factors using the inverse of variance method.Results:A total of 38 studies met criteria for syntheses. The pooled prevalence of clinically diagnoseddementia derived from an overall sample of 6964 older community-dwellers was 4.0% (95% C.I=3.0%-6.0%). We observed a pattern of distinctly low rates in West Africa (2.0%, 95% C.I=2.0%-3.0%)andhigher rates in East and Central Africa (6.0%, 95% C.I=5.0%-8.0%). Older age was the dominant factorassociated with prevalent dementia. This factor contributed 99.3% of the total variance of allsystematically associated factors. Most of the weight of association of older age and dementia wasprovided by studies conducted in West Africa (the region with the lower estimated prevalence).Conclusion:There are subsisting evidence gaps precluding robust estimation of age-adjusted prevalenceof dementia in SSA. Nevertheless, the findings from the present study provide useful information aboutthe possible mechanisms underlyingthe observed low prevalence of dementia in SSA and otherdeveloping countries. Keywords:Low and Middle income countries; sub-Saharan Africa; Dementia; prevalence; epidemiology;pooled estimates ResumeContexte: Les resultats contradictoires des etudes epidemiologiques individuelles ne permettent pas desupposer valides sur la prevalence reelle de la demence en Afrique subsaharienne (ASS). Nous avonseffectue une revue systematique et une meta-analyse des etudes sur la demence en Afrique subsaharienne pour arriver a une estimation de la prevalence regroupee et des facteurs associes.Materiel et methodes: Nous avons effectue des recherches dans Medline, EMBASE, PsychINFO etJournaux Africain En Ligne a l’aide d’index mots-cles Medicus pour la demence et l’operateur mp pourtous les 54 pays ou regions d’Afrique subsaharienne. De plus amples informations ont ete obtenues grâce a une recherche manuelle des references des articles pertinents. Nous avons inclus des etudes originales evaluees par des pairs avec des plans epidemiologiques ou experimentaux, effectue une meta-analyse aeffet aleatoire des estimations de la prevalence et determine les facteurs associes en utilisant la methode de l’inverse de la variance.Resultats: Au total, 38 etudes repondaient aux criteres de synthese. La prevalence groupee de demencediagnostiquee cliniquement derivee d’un echantillon total de 6964 d’habitants plus âges de lacommunaute etait de 4,0% (IC a 95% = 3,0% a 6,0%). Nous avons observe un schema de taux nettementbas en Afrique de l’Ouest (2,0%, IC 95% = 2,0% -3,0%) et des taux plus eleves en Afrique de l’Est etCentrale (6,0%, IC 95% = 5,0% -8,0%). L’âge avance etait le facteur dominant associe a la demenceprevalente. Ce facteur a contribue a 99,3% de la variance totale de tous les facteurs systematiquement associes. La majeure partie de lacharge de l’association entre l’âge avance et la demence a ete fournie par des etudes menees en Afrique de l’Ouest (la region avec la prevalence estimee la plus faible).Conclusion: Il existe des lacunes dans les preuves qui empechent une estimation robuste de la prevalence de la demence ajustee selon l’âge en ASS. Neanmoins, les resultats de la presente etude fournissent des informations utiles sur les mecanismes possibles a l’origine de la faible prevalence observee de la demence en Afrique subsaharienne et dans d’autres pays en developpement. Mots-cles: Pays a revenu faible et intermediaire ; Afrique Sub-Saharienne ; Demence; prevalence ;epidemiologie; estimationsgroupees Correspondence: Dr. A. Ojabemi, Department of Psychiatry, College of Medicine, Unversity of Ibadan, Ibadan, Nigeria. Email: drakinjagbemi@yahoo.com; akinojagbemi@gmail.com
Background: Young female graduates are mostly young women with pregnancy intentions. Utilization of preconception care (PC) by women will reduce maternal mortality which is very high in Nigeria. The aim of the study was to assess knowledge, perception and practice of PC among female graduates. The study was carried out in Ibadan, Southwest Nigeria. Methods: The study was cross-sectional in design and carried out in the National Youth Service Corps Secretariat, Ibadan North Local Government Area (LGA), Agodi Area, Ibadan, Oyo State. A total sampling of 426 females was done. A structured questionnaire adapted from 3 previously validated instruments was used. Results: Their mean age was 24.4± 2.6 years. Majority, 344(80.8%) were single and 295 (69.2%) were University graduates. Majority, 354 (83.1%) had never been pregnant. Mean knowledge score was 12.0 ± 4.5 out of 25. Only 41.4% had good knowledge. Mean perception score was 62.2 ± 7.6 out of 77 and 426 (100%) had positive perception. Mean practice score was 2.9 ± 3.8out of 14. Only 21.2% of those intending to be pregnant had good practice of PC. A higher proportion of respondents aged 25-30 years (47.8%) had good knowledge of PC. Older age, 25-30years, was a predictor of good knowledge of PC (OR: 1.5, 95% CI:1.04-2.27). A higher proportion of respondents who had good knowledge of PC had good practice. This was statistically significant. Knowledge of PC was a predictor of good practice (OR: 1.83, 95% CI: 1.10 – 3.06). Conclusion: Knowledge and practice of PC among young female graduates is poor. Health education intervention on all aspects of PC is needed among these young women. Keywords: Preconception care, female graduates, youth corps members AbstraitContexte: Les jeunes femmes diplomees sont pour la plupart des jeunes dames ayant des intentions de grossesse. L’utilisation des soins pre-conceptionnels (SP) par les femmes reduira la mortalite maternelle qui est tres elevee au Nigeria. Le but de l’etude etait d’evaluer les connaissances, la perception et la pratique de SP parmi les femmes diplomees. L’etude a ete realisee a Ibadan, dans le sud-ouest du Nigeria. Methodes: L’etude etait transversale dans sa conception et realisee au Secretariat du Corps de la Jeunesse pour le Service National, Ibadan North Local Government Area (LGA), Agodi Area, Ibadan, Oyo State. Un echantillonnage total de 426 femmes a ete effectue. Un questionnaire structure adapte de 3 instruments prealablement valides a ete utilise. Resultats: Leur âge moyen etait de 24,4 ± 2,6 ans. La majorite, 344 (80,8%) etaient celibataires et 295 (69,2%) etaient des diplomes universitaires. La majorite, 354 (83,1%) n’avaient jamais ete enceintes. Le score moyen des connaissances etait de 12,0 ± 4,5 sur 25. Seulement 41,4% avaient de bonnes connaissances. Le score de perception moyen etait de 62,2 ± 7,6 sur 77 et 426 (100%) avaient une perception positive. Le score de pratique moyen etait de 2,9 ± 3,8 sur 14. Seulement 21,2% des femmes ayant l’intention d’etre enceintes avaient de bonnes pratiques de SP. Une proportion plus elevee de repondantes âges de 25 a 30 ans (47,8%) avait une bonne connaissance de SP. L’âge plus avance, 25-30 ans, etait un predicteur de bonne connaissance de SP (OR:1,5, IC a 95% : 1,04 -2,27). Une proportion plus elevee des repondantes ayant une bonne connaissance de SP avait de bonnes pratiques. Ceci etait statistiquement significatif. La connaissance de SP etait un predicteur de bonnes pratiques (OR : 1,83, IC a 95% : 1,10 - 3,06). Conclusion: La connaissance et la pratique de SP chez les jeunes femmes diplomees sont faibles. Une intervention d’education sanitaire sur tous les aspects de SP est necessaire chez ces jeunes femmes. Mots cles: soins pre-conceptionnels, femmes diplomees, membres du corps des jeunes Correspondence: Dr. Mary O. Balogun, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: mobalogun2004@yahoo.com
