Comparison of the effectiveness of levonorgestrel intrauterine system and dienogest in the management of adenomyosis: A systematic review and meta-analysis.

BACKGROUND: Adenomyosis is a gynaecological lesion that impairs female fertility and contributes to reduced quality of life. There are several surgical and medical options for the management of this lesion; however, women who wish to conceive opt for medical therapies such as the levonorgestrel intrauterine device (LNG-IUS) and dienogest, which have various outcomes. To date, there is no consensus regarding which is more effective. OBJECTIVES: To compare the effectiveness of LNG-IUS and dienogest for the management of adenomyosis, and explore the risk of occurrence of known side effects for both treatments. DESIGN: Systematic review and meta-analysis exploring the effectiveness of LNG-IUS and dienogest for the management of adenomyosis. METHODS: A literature search was conducted using PICO guidelines and EMBASE, PubMed/MEDLINE, Scopus and Web of Science databases. Only clinical trials were collected and analysed. RESULTS: Of the 792 studies that were initially identified, six were eligible for inclusion in this study. The studies included a total of 707 women; of these, 270 were treated with LNG-IUS, 354 were treated with dienogest, and 83 were controls. All the studies were from Asia (Bangladesh n = 1, China n = 2, India n = 1, Japan n = 1, South Korea n = 1). Dienogest was found to reduce pelvic pain significantly, evidenced by a lower visual analogue scale score, compared with LNG-IUS. Also, dienogest led to a significant reduction in uterine volume compared with LNG-IUS. However, subjects in the LNG-IUS group had significantly higher levels of haemoglobin than those in the dienogest group. Nonetheless, the occurrence of side effects such as weight gain, breast tenderness/distension, headache, insomnia/sleep disorder, depression/mood disorder, skin disorder/acne, and coital discomfort/reduced libido were comparable in both treatment groups. CONCLUSION: Dienogest may be more effective than LNG-IUS for the management of adenomyosis, as it shows a superior effect in the reduction of pelvic pain and uterine volume. As only six studies were included in the present meta-analysis due to the paucity of data in the literature, it is recommended that well-designed randomized controlled trials comparing the effectiveness of dienogest with LNG-IUS should be conducted.

MAJOR DEPRESSIVE DISORDERS IN PAEDIATRIC SURGICAL PATIENTS: AN OVERVIEW OF THE NIGERIAN ADOLESCENTS.

Introduction: Less than three decades ago, depression was seen as a predominantly adult disorder as children were considered too developmentally immature to experience depressive disorders, and adolescent low mood was considered as part of 'normal' teenage mood swings. Major depressive disorder in children and adolescents is a serious psychiatric illness especially in paediatric surgical patients. This may be due to their altered metabolic rate and heighten metabolic response to trauma which has significant implications for the psychological development of the child, yet it remains under-recognized and undertreated. The well-being of the care givers is also not left out as the care givers are inundated with the task of sourcing and providing finance for hospital care., in addition to the stress of providing care for the patient. This may result in loss of man hour, sleeplessness, and physical exhaustion associated with caring for these ill children which can ultimately significantly increase the risk of them having depressive episode. The aim of this commentary is to highlight the fact that paediatric surgical patients are not exempt to having a major depressive disorder and the care givers should also be evaluated during hospital admission of their wards. Methodology: This is a commentary on depressive disorders among Nigerian paediatric surgical patients. Related publications on children and adolescents presenting to hospital were searched using the domain - Depression in Nigerian adolescent, Paediatric surgery patients on PubMed, Google Scholar, and MEDLINE to appraise this review. Conclusion: Mood disorders, especially depression in children and adolescents have been studied increasingly over the last two decades and surgical conditions worsen the outlook, culminating in increased knowledge about the presentation, and treatment. Despite this, it is still often missed or misdiagnosed because it sometimes presents with uncharacteristic symptoms. Prevalence of depressiion among paediatric surgical patient were found to be between 46-82% in this review among Nigerian patients.

CLINICAL PROFILE AND PATTERN OF DEMENTIA IN A GERIATRIC CENTRE.

Background: Knowledge on the clinical presentation of dementia is essential for appropriate care, especially in Low-and-Middle-Income Countries where these cases are on a sharp rise and can also aid early detection of other underlying conditions.This study sought to provide a broad and updated socio-demographic, clinical profile, pattern of diagnosis and treatment features of people diagnosed with dementia in this setting. Method: A retrospective cohort study which reviewed the medical case records of all older adults with dementia receiving treatment at the psychogeriatric and the neurology clinic of the Geriatric Centre (N=192). A proforma was designed to collect information from the case records. Results: The mean (±SD) age of the participants was 74.0(±7.2) years, 97.9% lived with other persons, 50.0% had at least one comorbidity and 52.6% presented late for treatment. Overall, hypertension (64.1%) and diabetes (22.4%) were the most common comorbidity, 55.2% had complaints bordering on behavioural problems; irrational speech (31.3%) being the most common, while 91.7% had forgetfulness as a cognitive symptom. Conclusion: A high rate of comorbidities, as well as late presentation was common among the participants. Our findings appraise the clinical importance of detailed knowledge of the patterns and profiles of older adults with dementia for early presentation and treatment.

Prognosticators of Excision of Giant Intra-Oral Tumors in a Resource-Challenged Setting: A Case Report.

Minor salivary glands are widely distributed in the mucosal surface of the lips, palate, nasal cavity, pharynx, and larynx, thus can arise from any of these primary sites. Intra-oral minor salivary gland tumors (IMSGTs), while considered rare in the general population are relatively more common when compared to all the other extra-oral sites. Pleomorphic adenoma, as seen in the index patient, is the most commonly diagnosed benign IMSGT. Intra-oral minor salivary gland tumors are not uncommon and depending on their size, nature, and location can be associated with severe limitation of the Patient's ability to breathe, speak clearly, and/or swallow and consequent severe morbidity and even mortality. In addition to these deleterious effects, they present a major surgical challenge to the surgeon, who has to determine the safest, most feasible access to ensure complete, or near-complete excision, as well as to the anesthetist, who needs to secure a definitive airway through the nose or mouth, both of which could be significantly restricted by the presence of the tumor. The aim is to present our successful management of one of the largest intra-oral minor salivary gland tumors documented in the literature, highlighting the specific measures we undertook to tackle the peculiar surgical and anesthetic challenges we faced. It had been two years since surgery and the patient is thriving with a markedly improved quality of life and no features of recurrence. The patient is a 50-year-old male with a slowly growing painless, left palatal mass in the roof of the mouth of 10 years duration with recurrent spontaneous bloody discharge effluent and snoring. There was an associated history of dysphagia to solid with associated choking spells, a left-sided facial asymmetry with no cheek swelling, odynophagia, sore throat, or difficulty with breathing. There was ipsilateral loss of upper incisors and dental anarchy about two years before presentation. No other nasal, otologic, or ophthalmic symptoms were present. No neck swelling, stiffness, cough, or chest symptoms. The oropharyngeal physical examination was highly restricted due to the intra-oral size of the mass. Figure 1. There was facial asymmetry with a bulge of the left maxilla, left-sided levels 1b and 2 non-tender lymph node enlargements, freely mobile, not adhered to the skin. A craniofacial CT scan revealed extensive isodense heterogeneously enhancing intra-oral soft tissue mass occupying the entire palate/oral cavity and encroaching laterally on the masticator and the parapharyngeal space with erosion of the left maxillary floor and hyoid bone Figure 2. The patient had an excision biopsy of the palatal mass with a free margin. No frozen section at the time of surgery. Histology revealed Pleomorphic adenoma and was followed up for 2 years with no evidence of recurrence. Prognosticators are delay in presentation leading to an increase in size of the mass and severe limitation of the patient's ability to breathe, speak clearly, and/or swallow and consequent severe morbidity and even mortality, the surgeon not being overwhelmed, the skillful Anaesthesist that could maneuver the nasal cavity without us doing tracheostomy and the successful outcome of the surgery.

Les glandes salivaires mineures sont largement réparties à la surface muqueuse des lèvres, du palais, de la cavité nasale, du pharynx et du larynx, et peuvent donc survenir à partir de l'un de ces sites primaires. Les tumeurs des glandes salivaires mineures intra-orales (TGSMIO), bien que considérées comme rares dans la population générale, sont relativement plus courantes par rapport à tous les autres sites extra-oraux. L'adénome pléomorphe, tel que celui observé chez le patient index, est la TGSMIO bénigne la plus fréquemment diagnostiquée. Les tumeurs des glandes salivaires mineures intra-orales ne sont pas rares et, en fonction de leur taille, de leur nature et de leur emplacement, peuvent être associées à une limitation sévère de la capacité du patient à respirer, à parler clairement et/ou à avaler, avec une morbidité sévère et même une mortalité. Outre ces effets délétères, elles présentent un défi chirurgical majeur pour le chirurgien, qui doit déterminer l'accès le plus sûr et le plus faisable pour assurer une excision complète ou presque complète, ainsi que pour l'anesthésiste, qui doit assurer une voie aérienne définitive par le nez ou la bouche, tous deux pouvant être significativement restreints par la présence de la tumeur. L'objectif est de présenter notre prise en charge réussie de l'une des plus grandes TGSMIO documentées dans la littérature, mettant en évidence les mesures spécifiques que nous avons prises pour relever les défis chirurgicaux et anesthésiques particuliers auxquels nous avons été confrontés. Deux ans après l'intervention, le patient se porte bien avec une nette amélioration de sa qualité de vie et aucune manifestation de récurrence. Le patient est un homme de 50 ans présentant une masse palatine gauche en croissance lente et indolore dans le palais depuis 10 ans, avec des écoulements sanguins spontanés récurrents et des ronflements. Il y avait une histoire associée de dysphagie aux solides avec des épisodes d'étouffement, une asymétrie faciale du côté gauche sans tuméfaction de la joue, une odynophagie, un mal de gorge ou des difficultés respiratoires. Il y avait une perte ipsilatérale des incisives supérieures et une anarchie entaire environ deux ans avant la présentation. Aucun autre symptôme nasal, otologique, ophtalmique n'était présent. Aucun gonflement du cou, raideur, toux ou symptômes thoraciques. L'examen physique de l'oropharynx était fortement limité en raison de la taille intra-orale de la masse. Figure 1. Il y avait une asymétrie faciale avec une bosse du maxillaire gauche, des ganglions lymphatiques non douloureux des niveaux 1b et 2 du côté gauche, mobiles librement, non adhérents à la peau. La tomodensitométrie craniofaciale a révélé une masse tissulaire molle intraorale extensive, hétérogène, rehaussée de manière isodense occupant l'ensemble du palais/cavité buccale et empiétant latéralement sur les muscles masticateurs et l'espace parapharyngé, avec érosion du plancher du maxillaire gauche et de l'os hyoïde. Figure 2. Le patient a subi une biopsie d'excision de la masse palatine avec une marge libre. Aucune section congelée n'a été réalisée lors de la chirurgie. L'histologie a révélé un adénome pléomorphe et un suivi de 2 ans n'a montré aucun signe de récurrence. Les facteurs pronostiques comprennent le retard de la présentation entraînant une augmentation de la taille de la masse et une limitation sévère de la capacité du patient à respirer, à parler clairement et/ou à avaler, avec une morbidité sévère voire une mortalité, le chirurgien ne se laissant pas dépasser, l'anesthésiste compétent pouvant manœuvrer dans la cavité nasale sans avoir recours à une trachéotomie, et le succès de l'intervention chirurgicale. MOTS-CLÉS: Intraoral; Glande salivaire mineure; Excision; Tumeur; Pronostiqueurs.

HAEMATOLOGICAL PARAMETERS AMONGST ACUTE STROKE PATIENTS MANAGED AT A TERTIARY HOSPITAL IN ABAKALIKI NIGERIA: A CASE-CONTROL STUDY.

Introduction: Changes in the haematological indices could have implications for stroke risk, management plan, and outcome. There are limited data on the pattern of haematological parameters of acute stroke patients in Nigeria despite its impact on stroke risk, management, and outcome. Objectives: To determine the pattern and the prognostic implications of the haematological parameters in acute stroke patients managed over a nine-year period at a Tertiary Hospital in Abakaliki Nigeria. Methodology: This was a retrospective hospital-based case-control study of the haematological parameters of acute stroke patients seen over a nine-year period at a tertiary hospital in Abakaliki Nigeria. Results: The mean total white blood cell count and percentage neutrophil in the case group were significantly higher than the control group while the mean packed cell volume did not show any significant difference. Further analysis of the case group revealed that the mean PCV was significantly lower among female folks, elderly age group, those with low education attainment, impaired renal status, short admission duration, haemorrhagic stroke, and admitting hypertension. On the other hand, mean total WBC count and differential neutrophils were significantly elevated among female folks, working-class age group, low educational status, longer admission duration, mortality, and haemorrhagic stroke. Conclusions: Elevated total white blood cell count and differential neutrophilia were significantly associated with acute stroke. Changes in haematological parameters have implications for stroke risk and outcome.

Napkin Dermatitis: Skin Hydration Levels and Skin Care Practices amongst Children at Urban Comprehensive Health Centre, Ile-Ife, Nigeria.

INTRODUCTION: Napkin Dermatitis (ND) means skin inflammation occurring within the napkin area. Skin care practices and skin hydration levels (SHL) are parameters of interest in the pathogenesis of ND. AIM AND OBJECTIVES: To compare napkin area skin care practices and levels of skin hydration in children with ND and those without ND and to determine the predictors of ND in children. METHODS: This was a case-control study of 60 participants with ND and 60 age and sex matched controls without ND, aged below 12 months that used napkins. Information on napkin area skin care practices were obtained from parents and diagnosis of ND was made clinically. Skin hydration levels were measured using a Corneometer®. RESULTS: The median age of children was 16 ± 17.1 weeks (range 2-48 weeks). Controls were more likely to use appropriate barrier agents compared with participants with ND (71.7% vs. 33.3%; p<0.001). There was no significant difference in the mean SHL ± SD of participants with ND and controls on the non-lesional (buttock) area (42.00 ± 19.71 vs. 43.46 ± 21.68; t = - 0.384, p= 0.702). Controls who always used a barrier agent were 83% less likely to have ND than those who did sometimes and those who never used a barrier agent (OR: 0.168, CI: 0.064-0.445, p< 0.001). CONCLUSION: Consistent use of an appropriate barrier agent could be protective against ND.

INTRODUCTION: La dermatite de la serviette (DN) désigne une inflammation cutanée survenant dans la zone de la serviette. Les pratiques de soins de la peau et les niveaux d'hydratation de la peau (SHL) sont des paramètres d'intérêt dans la pathogenèse de la DN. BUT ET OBJECTIFS: Comparer les pratiques de soins de la peau de la zone de la serviette et les niveaux d'hydratation de la peau chez les enfants atteints de MN et ceux qui ne le sont pas, et déterminer les facteurs prédictifs de la MN chez les enfants. MÉTHODES: Il s'agit d'une étude cas-témoins portant sur 60 participants atteints de MN et 60 témoins non atteints de MN, appariés selon l'âge et le sexe, âgés de moins de 12 mois et utilisant des serviettes. Les parents ont fourni des informations sur les pratiques de soins de la peau sur les serviettes et le diagnostic de la MN a été posé cliniquement. Les niveaux d'hydratation de la peau ont été mesurés à l'aide d'un Cornéomètre®. RÉSULTATS: L'âge médian des enfants était de 16 ± 17,1 semaines (intervalle 2-48 semaines). Les témoins étaient plus susceptibles d'utiliser des agents de barrière appropriés que les participants atteints de MN (71,7 % contre 33,3 % ; p<0,001). Il n'y a pas de différence significative entre la moyenne des SHL ± SD des participants atteints de MN et des témoins sur la zone non-lésionnelle (fesse) (42,00 ±19,71 vs. 43,46 ± 21,68 ; t= -0,384, p= 0,702). Les témoins qui utilisaient toujours un agent barrière étaient 83 % moins susceptibles de souffrir de MN que ceux qui le faisaient parfois et ceux qui n'utilisaient jamais d'agent barrière (OR : 0,168, IC : 0,064 - 0,445, p< 0,001). CONCLUSION: L'utilisation systématique d'un agent barrière approprié pourrait être un facteur de protection contre la MN. Mots clés: Dermatite de la Nappe, Hydratation de la Peau et Soins de la Peau.

Prevalence of Hyponatremia in Acute Stroke Patients in a Federal Teaching Hospital, Abakaliki, Nigeria.

BACKGROUND: Hyponatremia is a common electrolyte imbalance which is readily observed in patients with neurological disorders such as stroke. It is associated with increased morbidity and mortality during and after hospitalization. There has not been any study to demonstrate the frequency of admission hyponatremia in acute stroke patients in Nigeria. It is against this backdrop that we embarked on this study to determine the frequency and pattern of admission hyponatremia in acute stroke patients in a Federal Teaching Hospital, Abakaliki, Nigeria. METHODS: This was a cross-sectional observational hospitalbased study undertaken at the Emergency unit of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from November 2021 to April 2022. RESULTS: Amongst the 177 acute stroke patients enrolled in the study, 58 (32.8%) had hyponatremia. Advanced age, alteration in consciousness, and haemorrhagic (intracerebral and subarachnoid haemorrhage) stroke were significantly associated with presence of hyponatremia. CONCLUSION: Admission hyponatremia is prevalent amongst acute stroke patients in Abakaliki, Nigeria and commonly associated with advanced age, alteration in consciousness and haemorrhagic stroke.

CONTEXTE: L'hyponatrémie est un déséquilibre électrolytique commun qui est facilement observé chez les patients atteints de troubles neurologiques tels que l'AVC. Elle est associée à une morbidité et une mortalité accrues pendant et après l'hospitalisation. Aucune étude n'a été menée pour démontrer la fréquence de l'hyponatrémie à l'admission chez les patients victimes d'un AVC aigu au Nigeria. C'est dans ce contexte que nous avons entrepris cette étude pour déterminer la fréquence et les caractéristiques de l'hyponatrémie à l'admission chez les patients victimes d'un AVC aigu dans un hôpital universitaire fédéral à Abakaliki, au Nigeria. MÉTHODES: Il s'agissait d'une étude transversale d'observation en milieu hospitalier entreprise au service des urgences de l'Alex Ekwueme Federal University Teaching Hospital d'Abakaliki, au Nigeria, de novembre 2021 à avril 2022. RÉSULTATS: Parmi les 177 patients victimes d'un AVC aigu inscrits à l'étude, 58 (32,8 %) présentaient une hyponatrémie. L'âge avancé, l'altération de la conscience et l'AVC hémorragique (hémorragie intracérébrale et subarachnoïde) étaient significativement associés à la présence d'une hyponatrémie. CONCLUSION: L'hyponatrémie à l'admission est prévalente chez les patients victimes d'un accident vasculaire cérébral aigu à Abakaliki, au Nigeria, et est souvent associée à un âge avancé, à une altération de la conscience et à un accident vasculaire cérébral hémorragique. Mots clés: Accident vasculaire cérébral aigu, hyponatrémie, urgence médicale, Abakaliki, Nigeria.

Atorvastatin-mediated downregulation of VCAM-1 and XO/UA/caspase 3 signaling averts oxidative damage and apoptosis induced by ovarian ischaemia/reperfusion injury.

BACKGROUND: Oxidative damage is critical in the pathogenesis of ovarian ischaemia/reperfusion (I/R) injury, and statins have been reported to exert antioxidant activity. However, the role of VCAM-1 and xanthine oxidase (XO)/uric acid (UA) in ovarian I/R injury is not known. Also, whether or not atorvastatin exerts antioxidant activity like other statins is unclear. OBJECTIVES: This study investigated the involvement of VCAM-1 and XO/UA in ovarian I/R injury and the likely protective role of atorvastatin. METHODS: Forty female Wistar rats were randomized into sham-operated, ischaemia, ischaemia/reperfusion (I/R), ischaemia and atorvastatin, and I/R and atorvastatin. RESULTS: In comparison with the sham-operated group, atorvastatin blunted ischaemia and I/R-induced distortion of ovarian histoarchitecture and follicular degeneration. Also, atorvastatin alleviated ischaemia and I/R-induced rise in XO, UA, and malondialdehyde, which was accompanied by inhibition of ischaemia and I/R-induced reductions in reduced glutathione level, enzymatic antioxidant activities and increase in myeloperoxidase activity and TNF-α and IL-6 levels by atorvastatin treatment. Additionally, atorvastatin blocked ischaemia and I/R-induced increase in VCAM-1 expression, caspase 3 activity, 8-hydroxydeoxyguanosine level and ovarian DNA fragmentation index. CONCLUSION: For the first time, this study revealed that atorvastatin-mediated downregulation of VCAM-1 and XO/UA/caspase 3 signaling averts oxidative injury, inflammation, and apoptosis induced by ovarian ischaemia/reperfusion injury.

Methanolic Moringa oleifera leaf extract protects against epithelial barrier damage and enteric bacterial translocation in intestinal I/R: Possible role of caspase 3.

Background: Activation of caspase 3 has been implicated in the pathogenesis of I/R injury in various organs, but there is a paucity of data on its role in IIRI. Also, no reports were found on the beneficial role of methanolic Moringa oleifera leaf extract (MMOLE) in IIRI. This study investigated the involvement of caspase 3 in IIRI, and the impact of MMOLE in IIRI. Methods: Male Wistar rats were randomized into five groups; the sham-operated group that was sham-operated and received 0.5 ml of distilled water for 7 days prior to sham surgery, and the IIRI, febuxostat (FEB) +IIRI, low dose MMOLE (LDMO)+IIRI, and high dose MMOLE (HDMO)+IIRI groups that underwent I/R and also received 0.5 ml of distilled water, 10 mg/kg of febuxostat, 200 mg/kg of MMOLE, and 400 mg/kg of MMOLE respectively for 7 days prior to I/R. Markers of hepatic function, oxidative stress, and inflammation as well as enteric bacterial translocation and histoarchitecture integrity of intestinal and hepatic tissues were evaluated. The bioactive components of MMOLE were also determined by GC-MS. Results: As revealed by GC-MS, the active bioactive components of MMOLE were thiosemicarbazone, hydrazine, 1,3-dioxolane, octanoic acid, 1,3-benzenediamine, 9-octadecenoic acid, oleic acid, nonadecanoic acid, 3-undecanone, phosphonic acid, and cyclopentanecarboxylic acid. MMOLE alleviated IIRI-induced rise in intestinal and hepatic injury markers, malondialdehyde, TNF-α, IL-6, and myeloperoxidase activities. MMOLE improved IIRI-induced suppression of reduced glutathione, thiol and non-thiol proteins, and superoxide dismutase, catalase and glutathione peroxidase activities. These were associated with suppression of IIRI-induced caspase 3 activity and bacterial translocation. Histopathological evaluation revealed that MMOLE attenuated IIRI-induced alterations in intestinal and hepatic histoarchitecture integrity. MMOLE also militated against increased absolute and relative intestinal and hepatic weight, intestinal and hepatic injuries, epithelial mucosal barrier dysfunction, and enteric bacterial translocation associated with IIRI by downregulating oxidative stress-mediated activation of caspase 3. Conclusion: IIRI is associated with a rise in caspase 3 activity. Also, MMOLE confers protection against IIRI, possibly due to its constituent bioactive molecules, especially hydrazine, 9-octadecenoic acid, 1,3-dioxolane, oleic acid, and nonadecanoic acid.

Community Advocacy and Capacity Building of Community Health Workers on Rheumatic Heart Disease in Osun State, Nigeria.

Rheumatic heart disease (RHD) is one of the leading causes of cardiovascular diseases in the world. The study aimed to assess awareness and capacity building on the diagnosis and prevention of RHD among Community Health Workers (CHWs) Nigeria. It was an interventional study, where 300 CHWs from public Primary Health Care (PHC) facilities were selected pre-assessed on the diagnosis and prevention of RHD before their training on RHD. Also, a post-test evaluation was done to reassess the CHWs awareness on RHD. Data were analyzed and RHD knowledge was scored and graded. Results showed, at pre-test evaluation, that 49% of the CHWs had good knowledge, 49.7% had fair knowledge while 4.1% had poor knowledge on the diagnosis and prevention of RHD, while post-test evaluation revealed that 100% of the CHWs had good knowledge. Awareness of the CHWs about the diagnosis and prevention of RHD was fair in the pre-test and improved after the training with all the CHWs having good knowledge. This showed the training was impactful. Intermittent assessment of the awareness and simultaneous training of the CHWs on RHD may be scaled up into a significant and effective measure in the armamentarium of community prevention of the disease.

La cardiopathie rhumatismale est l'une des principales causes de maladies cardiovasculaires dans le monde. L'étude visait à évaluer la sensibilisation et le renforcement des capacités sur le diagnostic et la prévention de la cardiopathie rhumatismale chez les agents de santé communautaire (ASC). au Nigeria. Il s'agissait d'une étude interventionnelle, dans le cadre de laquelle 300 ASC des établissements publics de soins de santé primaires (PHC) ont été sélectionnés et pré-évalués sur le diagnostic et la prévention des RHD avant leur formation sur les RHD.. De plus, une évaluation post-test a été réalisée pour réévaluer la connaissance des ASC sur la RHD. Les données ont été analysées et les connaissances sur la RHD ont été notées et évaluées. Les résultats ont montré, lors de l'évaluation du pré-test, que 49% des ASC avaient une bonne connaissance, 49,7 % une connaissance moyenne et 4,1 % une mauvaise connaissance du diagnostic et de la prévention de RHD, tandis que l'évaluation du post-test a révélé que 100% des ASC avaient de bonnes connaissances. La connaissance des ASC sur le diagnostic et la prévention de la RHD était moyenne dans le pré-test et s'est améliorée après la formation, tous les ASC ayant de bonnes connaissances. Cela montre que la formation a eu un impact. L' évaluation intermittente de la sensibilisation et la formation simultanée des ASC sur la RHD peut devenir une mesure significative et efficace dans l'arsenal de prévention communautaire de la maladie. Mots-clés: Cardiopathie rhumatismale, Agents de santé communautaire, service de santé, prévention.

Glutamine prevents upregulation of NF-kB signaling and caspase 3 activation in ischaemia/reperfusion-induced testicular damage: An animal model.

AIM: Testicular ischaemia/reperfusion (I/R) injury is a major consequence of testicular torsion with possible attendant risk of male infertility. Glutamine, on the other hand, is a known antioxidant with anti-inflammatory potential. The present study evaluated whether or not glutamine would improve I/R-induced testicular injury in torsion/detorsion (T/D). The possible associated mechanisms were also investigated. METHODS: Wistar rats were randomly allotted into four groups (n = 10); sham-operated, glutamine-treated, T/D, and T/D + glutamine. Testicular torsion was induced and reperfusion established after two and a half hour under ketamine/xylazine anaethesia. Glutamine was administered one hour before reperfusion and continued daily for 3 days. At the end of the study, animals were euthanized, blood samples obtained, epididymal sperm suspension collected, and the testes harvested for biochemical and histopathological assays using established methods. RESULTS: Glutamine prevented T/D-driven I/R-induced reduced sperm quality, impaired testicular histoarchitecture, and suppressed circulating testosterone. Also, glutamine abated I/R-induced oxidative stress (evidenced by reduced hydrogen peroxide and MDA generation and enhanced concentrations and activities of antioxidants), inflammation (evidenced by suppression of TNF-α and IL-1ß), and apoptosis (evidenced by reduced DNA fragmentation) by down-regulating NF-kB and caspase 3 activity. CONCLUSION: For the first time, this study demonstrated that glutamine administration improved testicular I/R injury in T/D rat model by maintaining testicular redox balance, and testicular integrity and function via inhibition of I/R-induced upregulation of NF-kB signaling and caspase 3 activation.

The perception and disposal practices of unused and expired medicines by households in an urban municipality, southwest Nigeria: A comparative cross-sectional study.

Unused, damaged, and expired medicines (UEMs) pose disposal challenges globally, despite their importance. The environmental disposal of UEMs portends public health consequences, hence, this study in high-density (HDS) and low-density (LDS) urban households in Southwest Nigeria. The comparative, cross-sectional study utilised multi-stage samplingto enrol 404 females, experienced in use and medicines safekeeping. The response rate was 93%. Data were analysed by IBM-SPSS, version 20. Continuous and categorical variableswere presentedin tables as mean(±SD), proportions (%), respectively while χ2 and logistic regression statistics determined differences between LDS and HDS (Pα > 0.05). 53.4% and 71.2% of respondents respectively had good knowledge and positive attitudes to safe disposal of UEMs. At least 31.5% of households don't stock medicines while antimalarial (57.3%), analgesics (52.7%) and antibiotics (49.7%) predominate in households and significantly different between LDS and HDS. 72.9% and 67.8%; 47.9% and 55.6% respondents in LDS and HDS, respectively, disposed of solid and liquid UEMs in storage bins, though 34.9% (LDS) and 16.7% (HDS) disposed of liquid UEMs in toilet/sink. There were significant differences in medicines abundance and disposal practices between LDS and HDS for solid and liquid medicines. 37.1% of respondents perceived consequences for the poor UEMs disposal, including accidental ingestion (76.6% vs 26.7%), land pollution (69.6% vs 36.7%), water pollution (72.4% vs 32.8%) and toxicity (58.3% vs 32.8%), respectively in LDS and HDS. Respondents' good knowledge and positive attitudes contrasted with poor UEMs disposal practices, which compromise public health. Legislation, compliance monitoring and enforcement are germane for incentive-driven UEMs recovery.

Sexual dimorphism in inorganic mercury toxicokinetics and the attendant lipotoxic and non-lipotoxic dyslipidemia in the rat.

The influence of variability in the biology of living organisms is poorly appreciated in toxicology. However, multiple lines of evidence indicate that sex-differences modulate toxicokinetics and toxicodynamics from cellular/molecular to whole animal levels resulting in different toxic responses of living organisms to xenobiotics exposure. In order to investigate the influence of sex in inorganic mercury (Hg) exposure, male and female Wistar rats were exposed to 0.5, 1.0 and 1.5 mg Hg/kg body weight orally as HgCl2 twice a week for 12 weeks. Higher Hg levels in the females (except heart) as compared to males were observed in the animals. At the highest dose of inorganic Hg, female renal Hg content was 3.3 times higher than that of the males. Mixed sexual dimorphism characterised circulating-lipid- and organ-lipid lipotoxic and non-lipotoxic dyslipidemia. The highest dose of inorganic Hg, induced hypercholesterolemia in the males as opposed to hypocholesterolemia in the female. Plasma and erythrocyte free fatty acids increased in both sexes, although the increase was more pronounced in the male. Reverse cholesterol transport was inhibited in the male at the highest dose of Hg, whereas female HDL became enriched with cholesterol. Female erythrocytes had all their lipids increased, whereas only male erythrocyte triglyceride increased. Brain cholesterol and phospholipids, and splenic phospholipids were depleted in both sexes. Our findings indicate that inorganic Hg exposure appears to affect Hg and lipid kinetics differently in both sexes, thus underscoring the need to develop sex-tailored approaches in the treatment of metal toxicosis and its metabolic outcomes.

Assessment of Pb contamination of soils, sediments and road dusts of the City of Lagos, Nigeria.

Lead (Pb) is of considerable concern among other heavy metals because of its toxic impact on the environment and human health. The geochemical nature and source-transport-fate of Pb in Nigeria's environmental media are relatively unknown. This study was undertaken to quantify and characterize Pb in soils, sediments and road dusts from Lagos, Nigeria. A total of forty-eight soil samples, seventeen sediment samples and thirteen roadside soils were collected from within Lagos metropolis. The samples were air-dried, screened, pulverized and sieved through 63-µm nylon mesh. Mineralogical constituent of samples were determined using X-ray diffraction. The sieved fractions and pulverized rock samples were digested and analyzed for elemental Pb components using inductively coupled plasma mass spectrometry (ICP-MS). The chemical fractionations of Pb in the samples were determined by sequential analysis. Lead isotope compositions of the samples were determined using quadrupole-based ICP-MS. Lead isotopic ratios and geo-accumulation indexes were used for discriminating and evaluating Pb sources. Quartz, microcline, K-feldspar, plagioclase and kaolinite were the preponderant minerals in powdered rocks, soils and sediments. The concentration (mg/kg) of elemental Pb in sediments and dusts for Lagos was 21-1963; 23-830 and 22-830, respectively. The plots (208Pb/207Pb)/(206Pb/207Pb) revealed that the Pb in the environmental media was derived from anthropogenic sources. The Pb isotopic ratios for soils, sediments and dusts were characterized by lower 208Pb/206Pb ratios, compared to bedrock. The Pb contents are held principally in the organic sulfide and reducible and carbonate phases. The Pb is held in very reactive geochemical phases, and these portend great risk to the environment and public health.

Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review.

BACKGROUND: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. METHODS: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. RESULTS: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd-5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. CONCLUSION: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy.

Evaluation of Tramadol-Midazolam-Ketamine Anaesthesia in Rabbits.

Selected anaesthetic indices of, and the heart rate, respiratory rate and rectal temperature responses of 6 healthyrabbits to the intramuscular administration of 2mg/kg midazolam and 25 mg/kg ketamine alone (MK) and combined with4mg/kg tramadol (MKT) were evaluated over a 60-min observation period. Time to loss of righting reflex with MKT(1.7±0.3min) was significantly (p˂0.05) shorter than with MK (4.2±1.5min). Duration of recumbency with MKT(76.8±5.1min) and MK (77.8±3.6min) were similar. Time to standing with MKT (9.3±1.1min) was shorter than with MK(15.2±2.4 min). Mean heart rates ranged from 204.7±13.0 to 257.5±3 beats/min with MK, and from 207.3±4.6 to 238.8±8.7beats/min with MKT. Mean respiratory rates ranged from 33.8±6.2 to 64.3±15.0 breaths/min with MK; from 36.2±2.5 to54.0±8.6 breaths/min with MKT. Mean temperature ranged between 38.0±0.2 and 38.9±0.2oC with MK and between37.9±0.3 and 39.1±0.1oC with MKT. Neither MK nor MKT produced analgesia. It was concluded that although the inclusionof tramadol did not produce analgesia, it produced a faster onset of action than midazolam-ketamine alone. Midazolamketamine-tramadol will be useful for non-painful procedures where rapid drug action is needed.

Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd­5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy

RAPD Profiling, DNA Fragmentation, and Histomorphometric Examination in Brains of Wistar Rats Exposed to Indoor 2.5 Ghz Wi-Fi Devices Radiation.

The advent of Wi-Fi connected high technology devices in executing day-to-day activities is fast evolving especially in developing countries of the world and hence the need to assess its safety among others. The present study was conducted to investigate the injurious effect of radiofrequency emissions from installed Wi-Fi devices in brains of young male rats. Animals were divided into four equal groups; group 1 served as control while groups 2, 3, and 4 were exposed to 2.5 Ghz at intervals of 30, 45, and 60 consecutive days with free access to food and water ad libitum. Alterations in harvested brain tissues were confirmed by histopathological analyses which showed vascular congestion and DNA damage in the brain was assayed using agarose gel electrophoresis. Histomorphometry analyses of their brain tissues showed perivascular congestion and tissue damage as well.

Clinical Presentation and Outcome of Sinonasal Tumors in a Nigerian Tertiary Hospital - 6-year Review.

BACKGROUND: Sinonasal tumor is an uncommon tumor in Nigeria, but the burden of the disease in terms of morbidity and mortality is on the increase. The aim of this study is to evaluate the pattern of presentation and outcome of sinonasal tumor in our center. METHODOLOGY: This was a retrospective review of all the patients with sinonasal cancer seen in Ear, Nose, and Throat Department of the hospital between January 2008 and December 2013. The patients' biodata, clinical presentation, stage of the disease at presentation, identifiable risk factors, histopathological findings, and outcome were presented. RESULTS: A total of 22 patients were diagnosed with sinonasal cancer out of 71 patients (31%) with head/neck cancers during the period of study. There were 12 males (54.5%) and 10 females (45.5%) with a mean age of 51 ± 2.1 years. Epistaxis, nasal blockage, and discharge were seen in all patients though 41% of patients presented first to the ophthalmologist due to proptosis. Identifiable risk factors were exposure to wood dust (29%) and petrochemical products in (11%). Most patients presented first at advanced stages of the disease (82%). Histologically, well-differentiated squamous cell carcinoma was the most common (54.6%) followed by nonintestinal well-differentiated adenocarcinoma in 18.2% and plasmacytoma (9.1%). Chemoradiation was the mainstay of management in (38%) though 13.6% had total maxillectomy with postsurgical chemoradiation and 50.4% defaulted due to cost of management. CONCLUSION: Health education on early presentation and efforts at early detection of the disease are needed to achieve cure. Exposure to the identifiable risk factors should be reduced by protective measures. Easy access to radiotherapy at affordable price will surely improve the outcome of this disease.