Barriers and solutions to effective mentorship in health research and training institutions in Nigeria: Mentors, mentees, and organizational perspectives.

Aims and Background: Mentoring relationships and programs have become a subject of global interest and their relevance is high in the ever-evolving health system. In Nigeria, informal system of mentoring is largely practiced. To be able to institutionalize mentoring program, there is need to explore the various challenges of mentoring process and suggest potential approaches for effective mentor-mentee relationship in health research institutions in Nigeria. Subjects and Methods: The study was designed to explore the barriers and solutions to mentoring process from the perspectives of the mentor, mentee, and organization in health research and training institutions in Nigeria. A cross-sectional descriptive design was employed and the study was conducted among 21 health researchers drawn from 24 health research institutions across the 6 regions of Nigeria. The nominal group technique was adopted in the data collection process. Results: The most frequently reported mentor challenges were "lack of understanding of mentorship process" (84.2%) and "lack of capacity for mentoring" (78.9%), while those of mentee were "mentor preference" (73.7%) and "lack of freedom of expression" (47.4%). "Culture of selfishness/individualism" (84.2%) and "lack of formal relationship" (63.2%) were the most mentioned systemic challenges. Training on mentoring process and relationship was mentioned as the most frequent approach to overcoming challenges for the three perspectives. Conclusion: Significant mentorship challenges exist in the Nigerian health, academic and research institution. Systematic approaches to finding and implementing the appropriate solutions are needed to circumvent these bottlenecks.

Respiratory symptoms and pattern of lung functions among commercial motorcyclists in Sagamu, Nigeria

Background: The relationship between occupational exposure to air pollutants and poor respiratory health is known. The motorcyclists commonly seek medical care for respiratory diseases in Nigeria.Objective: To determine the prevalence of respiratory symptoms and the pattern of lung functions among commercial motorcyclists compared to control subjects.Method: The controlled cross-sectional study was conducted in Sagamu, an urban town in south-western, Nigeria. The commercial motorcyclists and the controls with similar age, non-smokers and same male sex were included in the study. The riders and controls recruited were non-smokers. A structured questionnaire approved by the British Medical Research Council/ATS (American Thoracic Society) was used. The pulmonary function tests were performed according to ATS recommendation.Results: A total of 200 subjects were studied: 100 were commercial motorcyclists and 100 were non-motorcyclist controls. Compared with the controls, the prevalence of cough (71% vs 21%) and sputum (67% vs 20%) was higher among the commercial motorcyclists. Twenty-one percent of the commercial motorcyclists had an obstructive ventilatory pattern compared to 13% of the control group.Conclusion: This study provides further evidence that commercial motorcyclists are exposed to occupational hazards which predisposed them to increased frequency of respiratory symptoms and impaired lung functions. Health education strategy may assist this group of workers and reduce the burden of respiratory disorders among them

RHEUMATOID ARTHRITIS ASSOCIATED WITH PULMONARY FIBROSIS IN NIGERIANS: TWO CASE REPORTS.

Rheumatoid arthritis may sometimes present with extra-articular involvement, pulmonary involvement is not common. Rheumatoid arthritis has been reported among Nigerians and extra-articular manifestations are rarely seen. One of the patients was misdiagnosed and mismanaged as a patient with pulmonary tuberculosis. The study is to demonstrate that rheumatoid arthritis is not as rare as previously reported in Nigeria and its pulmonary involvement can mimic tuberculosis or other granulomatous lung disorder. Clinical and serological acumen are necessary to distinguish between the two. Two diagnosed patients with rheumatoid arthritis and pulmonary involvement seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), are hereby presented.

FEMALE GENITAL TRACT CANCERS IN SAGAMU, SOUTHWEST, NIGERIA.

OBJECTIVE: To describe pattern of female genital tract cancers seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. DESIGN: This is a retrospective review of all cases of female genital tract cancers managed at the Gynaecology department of OOUTH, Sagamu, Nigeria. SETTING: OOUTH is a tertiary health institution of the State's university and it takes referrals from within and outside the State. SUBJECTS: Case records of all female genital tract cancers managed between January 2004 and December 2013 were retrieved and analysed using SPSS version 16.0. RESULTS: There were 2059 women treated forvarious gynaecologic conditions, 179 (8.7%) were cases of female genital tract cancers and 161 records were available for analysis. Cervical cancer constituted the commonest (51.6%), followed by ovarian (35.4%), endometrial (9.9%), and choriocarcinoma (1.9%). There were no cases of vaginal and fallopian tube cancers. The lowest mean age was found in choriocarcinoma (36.60 ± 4.50 years) and highest in vulvar cancer (70.00 ± 2.82 years). The mean ages for cervical, endometrial and ovarian cancers were (51.98 ± 12.39), (65.38 ± 7.24), and (54.42 ± 10.51) years respectively. Similarly the least mean parity was found in choriocarcinoma (2.33 ± 1.52), and the highest in vulvar cancer (6.00 ± 1.44). The mean parity for cervical, endometrial, and ovarian were (4.10 ± 1.49),(3.06 ± 1.48), and (3.72 ± 1.68) respectively. These differences are statistically significant, age; F = 7.61, p < 0.0001, and parity; F = 3.27, p= 0.013. CONCLUSION: Incidence of cervical, endometrial, and ovarian cancers remain high and presentations are at late stages. There is a need to improve on cervical cancer screening, and for the attending physicians to improve on their indices of suspicions as regards endometrial and ovarian cancers.

EFFECT OF PRE-OPERATIVE SUB-LINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN ON CAESAREAN OPERATION BLOOD LOSS.

BACKGROUND: Caesarean operation remains the most common abdominal surgery in women and has immense benefits to both mother and baby when employed. Haemorrhage, however, remains the greatest challenge associated with its outcome. OBJECTIVE: To compare the effectiveness of pre-operative sub-lingual misoprostol with intravenous oxytocin administered after delivery of the neonate in minimising blood loss at Caesarean operation. DESIGN: A prospective study. RESULTS: The mean blood loss was significantly lower in misoprostol group compared to oxytocin group (517.32mls versus 621.22mls; p = 0.005). The drop in haematocrit was significantly lower in misoprostol group than the oxytocin group, (400 µg-misoprostol versus oxytocin: 1.88 versus 3.04; p = 0.0001). Side effects of chills, shivering and pyrexia were noted more with the use of misoprostol. CONCLUSION: Pre-operative sub-lingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss at Caesarean section operation. However, occurrence of transient side effects of chills, shivering and pyrexia were noted more with use of misoprostol.

Post-partum mental disorders in Sagamu.

BACKGROUND: Pregnancy and labour are sufficiently stressful to precipitate mental disorders in women after delivery. This may arise newly, as a recurrence or an exacerbation of previously existing mental illness in the individual woman. Postpartum mental disorders are under reported in our practices. OBJECTIVE: To determine the incidence of post-partum mental disorders in our practice, pattern of presentation and the commonly associated factors. DESIGN: A retrospective descriptive study. SETTING: Olabisi Onabanjo University, Sagamu, Nigeria. RESULTS: During the study period there were a total of 9085 deliveries and 27 cases of puerperal mental illness. This gave an incidence of 2.9 per 1000 births. The mean age and mean parity of patients were 27.3 (+/- 7.9 SD) and 2.3 (+/- 1.8 SD) respectively. The mean delivery-presentation interval and mean length of hospitalisation were 11.5 (+/- 7.15 SD) and 12.4 (+/- 5.8) respectively. CONCLUSION: Incidence of post-partum mental illness in our practice is 2.9 per 1000 births. There were preponderance of primiparity and young maternal age in the study group. Family history of psychiatric disorders and marital disharmony appear to play major role in the aetiology of these disorders in our practice.

Typhoid fever associated with severe hepatitis.

While typhoid is quite common in our environment, presentation in association with severe hepatitis and hepatic encephalopathy is uncommon. The case of a 14 year old male with typhoid who presented with jaundice and severe hepatitis with encephalopathy is presented. The first symptoms occurred one week before presentation. The clinical features and laboratory investigations confirmed typhoid fever. The associated severe hepatitis could have been related to a direct liver involvement by Salmonella typhi, drug toxicity or hepatitis B infection from previous indiscriminate parenteral drugs. The specific cause of the hepatitis could not be confirmed. The patient is presented to illustrate a rare association and possible complication of typhoid fever, inappropriate self and other medication in the place of proper hospital presentation and assessment and the diagnostic difficulties confronting many centres in the developing environment.

Severe large and small bowel fibrosis clinically mimicking gross splenomegaly.

The case of an 18-year-old female, with mild left hypochondrial pain and an abdominal mass mimicking gross splenomegaly, with severe small and large bowel fibrosis and adhesions and numerous mononuclear cellular infiltrate on histology, is presented. A clear picture of intestinal obstruction only unfolded terminally. She died within 48 hours of presentation. Our patient illustrates the fact that severe intestinal adhesions may present with very mild symptoms and signs and therefore a high index of suspicion is necessary, to reduce the attendant high mortality in intestinal obstruction in our environment.