Sex-ratio at birth in Nigeria: A demographic perspective

The study attempts at estimating the sex-ratio at birth in Nigeria. The study focuses on demographic surveys with complete maternity histories, including some 0.50 million births. It compares results with published estimates from births in health facilities and a few data from vital registration, including some 1.13 million births. Results from demographic surveys give an estimate of about 106 boys for 100 girls. There were no significant variations by large region in the country, and no significant trend over the years (1990-2018). Published estimates provided a similar value (106.2), with somewhat lower value in health facilities (105.3), and somewhat higher values in local vital registration (106.8), and major variations among available studies. Despite uncertainty, Nigeria appears to have higher sex-ratios than most African countries, with the exception of Ethiopia, and higher values than its five neighboring countries. Reasons for these high values of the secondary sex-ratio are discussed. (Afr J Reprod Health 2022; 26[4]: 92-97).

Factores de riesgo de Bronquiolitis en pacientes menores de 2 años

Resumen Introducción: Se estima que a nivel mundial, cada año alrededor del 10% de los lactantes tienen bronquiolitis. Se produce un pico entre los 2 y los 6 meses de edad. Objetivo: Determinar los factores de riesgo de bronquiolitis en menores de dos años que consultaron al servicio de Pediatría del Instituto de Medicina Tropical entre el 2018 y 2019. Método: Estudio de tipo descriptivo, transversal en el que se incluyeron pacientes menores de 2 años internados en el Servicio de Pediatría del Instituto de Medicina Tropical de enero de 2018 a febrero de 2019 con diagnóstico de bronquiolitis en el que se analizaron los factores de riesgo de la enfermedad. Resultados: Se estudió una población de 38 pacientes que presentaron bronquiolitis antes de los 2 años, 19 fueron niños (50%) La edad media al ingreso fue de 3,5 ± 2,8 meses (límites, 1-10 meses). No se han encontrado datos de tabaco en el embarazo. Se detectó VRS en el aspirado nasofaríngeo de 8 niños (21%), la detección viral fue negativa en 14 niños (37%) y no se realizó la determinación en 18 casos (47%). Los siguientes factores de riesgo se asociaron de forma independiente con la bronquiolitis: Asma de los padres, infección por VSR, sibilancia, cianosis y hacinamiento. Los factores de riesgo estudiado, exposición al tabaco, sexo, edad en el momento de la bronquiolitis o lactancia materna exclusiva, no se asociaron con el ingreso a UTI de los pacientes con bronquiolitis. Conclusión: Hemos encontrado factores de riesgo asociado relacionados al huésped como asma de los padres, y otros como sibilancia, cianosis, hacinamiento e infección por VRS.

Abstract Introduction: It is estimated that globally, each year around 10% of infants have bronchiolitis. A peak occurs between 2 and 6 months of age Objective: To determine the risk factors of bronchiolitis in children less than two years of age who admitted at the pediatric service of the Institute of Tropical Medicine between 2017 and 2019 Method: A descriptive, cross-sectional study in which patients under 2 years of age admitted to the Pediatric Service of the Institute of Tropical Medicine from January 2018 to February 2019 were included with a diagnosis of bronchiolitis in which the risk factors of the disease were analyzed. Results: We studied a population of 38 patients who presented bronchiolitis before 2 years, 19 were children (50%) The average age at admission was 3.5 ± 2.8 months (range, 1-10 months). No tobacco data were found in pregnancy. RSV was detected in the nasopharyngeal aspirate of 8 children (21%), viral detection was negative in 14 children (37%) and the determination was not made in 18 cases (47%). The following risk factors were independently associated with bronchiolitis: Asthma of the parents, RSV infection, wheezing, cyanosis and overcrowding. The risk factors studied exposure to tobacco, sex, age at the time of bronchiolitis or exclusive breastfeeding were not associated with admission to the ICU of patients with bronchiolitis. Conclusion: We have found associated risk factors related to the host such as asthma of the parents, and others such as wheezing, cyanosis, overcrowding and RSV infection.

Cisatracurium Pretreatment with Tourniquet - Role in Propofol Injection Pain: A Prospective, Randomized, Double Blind and Control Study

Introduction: Propofol is an anaesthetic drug which is given toinduce and maintain anaesthesia in adults undergoing surgery.This prospective, randomized, controlled study was designedto evaluate the efficacy of cisatracurium as a pretreatment drugin reducing incidence and severity of propofol injection pain.Material and methods: Patient undergoing generalanaesthesia were randomized in four groups of 25 patientseach. Group A received normal saline (control group), GroupB received Cisatracurium 0.05mg/kg IV, Group C receivedCisatracurium 0.1mg/kg IV, Group D received Cisatracurium0.15mg/kg IV. All drugs were administered into the largestdorsal vein of the hand with venous occlusion for 30 sec,followed by propofol (0.5mg/kg). Pain was evaluated usinga four point scale.Result: Cisatracurium 0.15mg/kg significantly lowers bothincidence and severity of propofol induced pain. Cisatracurium0.1mg/kg and cisatracurium 0.05mg/kg both significantlylower the severity of pain but not the incidence as comparedto control group.Conclusion: Cisatracurium is an effective drug in reducingpropofol induced pain. It reduces the incidence and severityboth of pain in 0.15mg/kg dose. Whereas only severityis decreased with 0.10 mg/kg and 0.05 mg/kg dose ofcisatracurium without any significant complications.

Papel de las infecciones virales en el asma / The role of viral infections in asthma

Respiratory viral infections have been implicated in the origin and exacerbation of asthma symptoms in a variety of ways. A growing body of evidence indicates that viral infections are closely linked to infantile wheezing and suggest that severe bronchiolitis in early infancy may predispose to chronic childhood asthma. Alternatively, it could represent a marker of susceptible individuals. In contrast, mild repetitive infections in early years may provide a protective role against the development of asthma or atopy by switching the immune system towards Th1 responses. However, evidence on this hypothesis is not consistent as far as viruses are concerned. On the other hand, in the presence of asthma, the role of viral infections on exacerbations is well established. Several factors, such as the presence of atopy, timing of the exposure and severity of the infections, interactively contribute to the asthma-infection relationship. In the present report, recent data on the involvement of viral infections in the development and progression of asthma are reviewed

Las infecciones virales respiratorias han sido involucradas en el origen y en las exacerbaciones de los síntomas del asma en una variedad de formas. Cada vez hay más indicios de que las infecciones virales están estrechamente relacionadas con sibilancias en la niñez y sugieren que la bronquiolitis grave en la primera infancia puede predisponer a asma crónica infantil; por otra parte, podría representar un marcador de individuos susceptibles. Por el contrario, las infecciones leves repetidas en los primeros años brindarían un efecto protector contra la aparición de asma o atopia mediante la desviación del sistema inmunitario hacia respuestas Th1. Sin embargo, la información relacionada con esta hipótesis no es firme en lo que a virus se refiere. Por otra parte, en presencia de asma, el papel de las infecciones virales sobre las exacerbaciones está bien establecido. Varios factores, como la presencia de atopia, el momento en el que se produce la exposición y la gravedad de las infecciones, interactúan en la relación entre asma e infección. En este artículo se revisan datos acerca de la participación de las infecciones virales en la aparición y progresión del asma

A substantial investigation of discrepancy between patient complaints and assessment by medical personnel in chemotherapy-induced nausea

Purpose： In this study, we aimed to investigate the discrepancy between interview by medical personnel using 3‒point verbal rating scale (VRS) and patient complaints using numerical rating scale (NRS) in nausea diary for chemotherapy‒induced nausea. Patients and Method： In this study, we targeted patients who received chemotherapy at the gynecology department in our hospital and who recorded information in nausea diary. The discrepancy was estimated from NRS in nausea diary and the degree of nausea obtained by medical interview at approximately the same time period. We classified it into overvaluation, undervaluation or non‒discrepancy. Result： A total of 663 cases was analyzed, and 54 patientswere enrolled. The discrepancy was 25.2％ (undervaluation 5.4%; overvaluation 19.8％), and mostly overvaluation was observed. NRS in nausea diary had a significant correlation with the degree of nausea obtained by medical interview（P<0.001, r=0.66） , and the kappa statistic was 0.36. Conclusion： Ratio of non‒undervaluation is approximately 95%; hence, we conclude that interview by medical personnel using VRS accurately reflects the degree of nausea.

Ventilación de alta frecuencia en infección respiratoria grave por VRS / High frequency oscillatory ventilation in severe RSV infection

High frequency oscillatory (HFOV) has been progressively useful in children with severe hypoxemic and Iry-percapnic respiratory insufficiency, at Pediatric Intensive Care Units. Objectives: To describe our experience in treatment of children with severe RSV infection unresponsive to conventional ventilation (CV), to describe effectiveness in gas exchange and to evaluate the safety of the method. A descriptive and prospective study set at two paediatric intensive care units, in Hospital Roberto del Río and Clínica Santa María of Santiago, Chile between January 2001 and December 2004. Results: 36 patients between 0.5 and 10 months of age with severe RSV infection and respiratory failure unresponsive to mechanical ventilation were connected to HFOV after an average time of conventional ventilation of 2.6 days. Arterial pH improved during the first hour in HFOV from 7.18 to > 7.3. Initial PaO2/FiO2 in average was 104.8, there was a slow and progressive improvement until 72 hours (138). FiO2 diminished since an average of 74 percent till 63.6 percent at 72 hours pCO2 went down from an average of 88 mm de Hg pre HFOV to 50 mmHg at 12 hours, remaining low. Oxygenation Index, preHFOV, was in average 18 and it maintained in 17 at 72 hours, with a FiO2 < 60 percent. Patients were hold in HFOV between 2-18 days. 3/36 patients died after 1.5, 4 and 18 days of HFOV. 8,3 percent presented air leak. One of these patients is oxygen dependent after 12 months of following. Conclusions: High frequency oscillatory ventilation is a useful method in the management of acute respiratory failure in children with severe infection for RSV unresponsive to conventional ventilation. It can improve gas exchange slowly and progressively with a low risk of air leak, secuelae and death.

La ventilación de alta frecuencia oscilatoria (VAFO) es un modo ventilatorio cada vez más utilizado en el manejo del paciente pediátrico con insuficiencia respiratoria grave, tanto hipoxémica como hipercápnica, en unidades de paciente crítico. Objetivos. Describir nuestra experiencia en el uso de VAFO en niños con infección respiratoria aguda grave por Virus Respiratorio Sincicial (VRS), su efectividad en el intercambio gaseoso y la seguridad del método. Método: Estudio descriptivo, retrospectivo, realizado en unidades de cuidado intensivo pediátricos de Hospital Roberto del Río y Clínica Santa María de Santiago, Chile, entre los meses de Enero 2001 y Diciembre 2004. Resultados: Se conectaron a VAFO 36 pacientes de 0,5 a 10 meses de edad con falla respiratoria aguda por infección por VRS y sin respuesta a VMC, luego de un promedio de 2,6 días. El pH arterial mejora durante la primera hora en VAFO, de 7,18 a 7,3. PaO2/FiO2 inicial promedio fue de 104,8, se observó una lenta y progresiva mejoría hasta las 72 horas (138). FiO2 disminuyó de 74 por ciento hasta 63,6 por ciento en las primeras 72 horas. La PCO2fue disminuyendo desde un promedio en VMC de 88 a 50 mmHg a las 12 horas, permaneciendo luego en rangos bajos. El índice de oxigenación pre VAFO, fue en promedio 18 y se mantuvo en 17 a las 72 horas de conexión, con una FiO2 < 60 por ciento. El tiempo de VAFO fue de 2-18 días. 3/36 pacientes fallecieron a los 1,5, 4 y 18 días de VAFO, 8,3 por ciento presentaron escape aéreo. 1/36 paciente es oxígeno dependiente luego de 12 meses de seguimiento. Conclusiones: VAFO se constituyó en un método eficaz en el manejo de la falla respiratoria aguda en niños con una infección grave por VRS, que no respondieron a la VMC. Podría mejorar rápidamente la hipercapnia, y la oxigenación lenta y progresivamente, con un bajo riesgo de escape aéreo, secuelas y mortalidad.

Circulación de los virus influenza durante la primera ola pandémica en Chile / Circulation of influenza virus during the first pandemic wave in Chile

Se caracteriza el comportamiento de la circulación de los virus respiratorios durante la primera ola del virus influenza pandémico A (H1N1) en 2009 en Chile, a partir de datos del sistema de vigilancia centinela en el sector público como a partir de consultas ambulatorias en el sector privado. La influenza A estacional tuvo escasa circulación durante el período estudiado, lo cual permitió plantear que la influenza A sin tipificar podría corresponder mayoritariamente a influenza pandémica A (H1N1). La importancia relativa del virus pandémico mostró un comportamiento que varió con la edad, afectando en forma más marcada a niños escolares entre 5 y 14 años y adultos jóvenes, y en menor proporción a los niños menores de 5 años, entre los cuales predominó como agente etiológico principal el virus respiratorio sincicial.

Circulation of respiratory viruses during the first wave of pandemic influenza virus A (H1N1) in 2009 in Chile isdescribed, from data extracted from the sentinel surveillance system in the public sector and from outpatient clinics from the private sector. Seasonal influenza A had little circulation during the period studied, which allowed us to suggest that the influenza A without classification could be mainly pandemic influenza A (H1N1). The relative importance of the pandemic virus varied with age, affecting more markedly school children between 5 and 14 years and young adults, and to a lesser extent, children under 5 years, among which the predominant primary etiologic agent was respiratory syncytial virus.