In-hospital psychoeducation for family caregivers of Nigerian children with cancer (The RESCUE Study).

OBJECTIVES: High levels of caregiver burden (CB) are experienced by informal caregivers of pediatric patients with cancer. There is increasing evidence highlighting the extent of CB across sub-Saharan African countries, although there remains lack of interventions that target improvements in their experience. This study aimed to determine the impact of a structured psychoeducation program on caregivers' outcomes relating to preparedness to provide care, burden of caregiving, and quality of life (QoL). METHODS: This quasi-experimental (pre-and-posttest) design, involved family caregivers of children on admission for cancer treatment in 4 Nigerian tertiary hospitals. Eligible participants received 2 structured, psychoeducational training sessions delivered by a multidisciplinary oncology team, focusing on the management of patients' condition, spiritual care, self-care, and support. RESULTS: Subjects were mainly female (79.5%) and mostly mothers to children undergoing cancer treatment (74.7%). Commonest cancer type was acute lymphoblastic leukemia (23.9%) with evidence of metastatic disease found in 9.6% of children. Significant improvements were observed between pre- and posttest for unmet needs (z = -9.3; p < 0.001), preparedness for caregiving in palliative care (PCPC) (z = -7.0; p < 0.001), and overall QoL (z = -7.3; p < 0.001). A significant reduction in CB was also reported (z = -8.7; p < 0.001). SIGNIFICANCE OF RESULTS: This psychoeducational intervention (PEI) resulted in significant improvements in unmet needs, CB and significant improvements in PCPC. However, a reduction in QoL of the family caregivers was also observed. Findings from this study should encourage the use of well-crafted PEIs, delivered within hospital settings to promote improvements in outcomes for informal caregivers of hospitalized children suffering from cancer, in an African context. Further intervention development is required to better understand intervention components influencing changes in outcomes, while exploring feasibility testing and adaptation to similar settings in Nigeria and within Africa.

Correlation of the transorbital ultrasonographic optic nerve sheath diameter with intracranial pressure measured intraoperatively in infants with hydrocephalus.

OBJECTIVE: Hydrocephalus is a highly significant global public health concern. In infants, it may be associated with a potentially deleterious increase in intracranial pressure (ICP). Currently, the gold standard for accurate monitoring of ICP is an intraventricular ICP monitor, but this method is invasive and expensive. Transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) may provide a noninvasive and cost-effective alternative method for monitoring ICP. The goal of the study was to determine the extent of the correlation between ultrasonographic ONSD and ICP in infants. METHODS: A prospective observational study of 47 children with hydrocephalus aged ≤ 18 months was performed. The ONSD was measured with a transorbital ultrasound scan, while the intraventricular CSF opening pressure was assessed using a manometer during ventriculoperitoneal shunt insertion. Data were analyzed using SPSS software. The ONSD and ICP measurements were correlated, the receiver operating characteristic (ROC) curve was evaluated, and a sensitivity analysis was performed. Inferences were made using the 0.05 alpha level of significance. RESULTS: The mean age of the study cohort was 4.8 ± 4.3 months, and 93.6% of patients were infants. The mean ONSD was 4.5 ± 0.7 mm (range 2.9-6.0 mm), and the mean ICP was 19.9 ± 6.5 mm Hg (range 5.2-32.4 mm Hg). Both ONSD and ICP increased with increasing age. The Pearson correlation coefficient revealed a strong positive correlation between ONSD and ICP (r = 0.77, p < 0.001). The ONSD cutoff points were 3.2 mm, 4.0 mm, and 4.6 mm for patients with ICPs of 10 mm Hg, 15 mm Hg, and ≥ 20 mm Hg, respectively. The sensitivity of ONSD was 97.7% (area under the ROC curve 0.99), and for every 14.3-mm Hg increase in ICP, the ONSD increased by 1.0 mm holding age constant. CONCLUSIONS: ONSD has a strong positive correlation with ICP. Correspondingly, ONSD is highly sensitive in estimating ICP.

Analyzing the impact of vaccinations and weather factors on the COVID-19 pandemic.

OBJECTIVES: A world-wide immunization project was launched at the peak of COVID-19 pandemic to contain and minimize the adverse effects of SARS-CoV-2 virus. We carried out a series of statistical analyses in this paper to determine, confirm and quantify the impact of the vaccinations on COVID-19 cases and mortalities, amidst critical confounding factors-temperature and solar irradiance. METHODS: The experiments in this paper were carried out on the world data, data from 21 countries, and the five major continents. The significance of the 2020-2022 vaccinations on the COVID-19 cases and mortalities response data were evaluated via Hypotheses' tests. Correlation coefficient analyses were carried out to determine the extent of the relationship between vaccination coverage and corresponding COVID-19 mortalities data. The impact of vaccination was quantified. The effects of the weather factors-temperature and solar irradiance, on COVID-19 cases and mortalities data were analyzed. RESULTS: The series of hypotheses tests carried out reveal that vaccinations did not affect cases; however, vaccinations significantly impacted the mean daily mortalities in all five major continents and globally. The correlation coefficient analysis results show vaccination coverage to be highly and negatively correlated with daily mortalities in the world-the five major continents and most of the countries studied in this work. The percentage reduction in mortalities as a result of wider vaccination coverage was indeed significant. Temperature and solar irradiance impacted daily COVID-19 cases and mortalities data during the vaccination and post-vaccination periods. CONCLUSION: Results show that the world-wide vaccination against COVID-19 project had a significant impact in reducing mortalities and minimizing the adverse effects due to COVID-19 globally, in all five (5) major continents of the world and the countries studied in this work, however, temperature and solar irradiance still had effects on COVID-19 response in the vaccination eras.

Cerebral artery conditional blood velocity in sickle cell disease: a multicentre study and evidence for active treatment.

OBJECTIVE: To obtain multicentre data on the prevalence of normal, high or conditional (intermediate) blood velocity in the cerebral arteries among children with sickle cell disease (SCD) in Nigeria. DESIGN: A prospective observational study in five tertiary healthcare institutions. By transcranial Doppler (TCD) ultrasonography, cerebral artery peak systolic blood velocity (PSV) was determined in 193 children with SCD and time averaged mean of the maximum blood velocity (TAMMV) in a different cohort of 115 children. This design was to make the findings relevant to hospitals with TCD equipment that measure either PSV or TAMMV. SETTING: Nigeria. PARTICIPANTS: 308 children (126 girls, 182 boys; age 2-16 years). MAIN OUTCOME MEASURES: Percentage of children with SCD who have normal, high or intermediate (often termed conditional) PSV or TAMMV. RESULTS: In the cohort of 193 children, PSV was normal in 150 (77.7%), high in 7 (3.6%) and conditional in 36 (18.7%). In the cohort of 115 children, TAMMV was normal in 96 (84%), high in 7 (6%) and conditional in 12 (10%). There were no significant differences in gender or age distribution between the PSV and TAMMV cohorts. Altogether, cerebral artery blood velocity was normal in 246/308 children (80%), high in 14 (4.5%) and conditional in 48 (15.5%). CONCLUSION: Since conditional blood velocity in cerebral arteries can progress to high values and predispose to stroke, the proportion of children with SCD who are affected (15.5%) raises the question of whether regular monitoring and proactive intervention ought to be the standard of care.

Clinical presentation, radiographic findings, and treatment outcomes in children with adenoid hypertrophy in a paediatric outpatient clinic in Enugu, Nigeria.

Objectives: To determine the clinical presentation, imaging features and outcomes of children with adenoid hypertrophy in our setting. Design: A retrospective study. Setting: The paediatric clinic of a private hospital in Enugu. Participants: 51 children, aged 2 to 108 months, with suggestive clinical features and radiographic report of adenoid hypertrophy who presented over 3 years. Interventions: Clinical information was obtained from the patient's medical records. Data was analysed for the clinical characteristics of the patients, the relationship between the degree of airway narrowing on a postnasal space (PNS) radiograph and treatment outcomes. Main outcome measures: Degree of airway narrowing as measured on a PNS radiograph, the type of and outcomes of treatment. Results: There was an almost equal male (54.7%): female (45.1%) ratio in the occurrence of adenoid hypertrophy, with a mean age of occurrence of 31.50 ± 3.64 months. Noisy breathing was the commonest symptom (94.1%); history of atopic rhinitis in 64.7% of cases and hyperactive airway disease in 45.1% more than 50% of cases with airway narrowing resolved with medical management only. Conclusion: Adenoid hypertrophy should be considered in evaluating the upper airway in children under five. Paediatricians should be conversant with diagnosing and managing this common cause of upper airway obstruction. Funding: None declared.

Pilot assessment of omega-3 fatty acids and potassium thiocyanate in sickle cell anemia patients with conditional peak systolic cerebral artery blood velocity.

OBJECTIVE: The purpose of this pilot study was to explore the effect of omega-3 fatty acids and potassium thiocyanate on conditional peak systolic cerebral artery blood velocity in children with sickle cell anemia (SCA). METHODS: Transcranial doppler ultrasonography (TCD) was done on 232 SCA children, and 21 found with conditional peak systolic blood velocity (PSV) of 200-249 cm/s in internal carotid, middle or anterior cerebral arteries. These were randomized to receive omega-3 fatty acids and potassium thiocyanate with standard treatment of SCA (test group, N = 14), or standard treatment only (control group, N = 7). After 3 months of treatment, PSV was measured again. RESULTS: Right middle cerebral artery PSV was significantly reduced in the test relative to the control groups (p = 0.04). PSV returned to normal in 79% of the test versus 43% of the control group; and increased to abnormal in one member of the control group, but none of the test group. CONCLUSIONS: The pilot data suggest that in SCA, omega-3 fatty acids and potassium thiocyanate might reduce conditional blood velocity to normal, or prevent progression to abnormal values. A larger, randomized, clinical trial is required to further address the current gap in management of conditional TCD blood velocity.

Project OPUS: Development and evaluation of an electronic platform for pain management education of medical undergraduates in resource-limited settings.

INTRODUCTION: Pain is a very frequent symptom that is reported by patients when they present to health professionals but remains undertreated or untreated, particularly in low-resource settings including Nigeria. Lack of training in pain management remains the most significant obstacle to pain treatment alongside an inadequate emphasis on pain education in undergraduate medical curricula, negatively impacting on subsequent care of patients. This study aimed to determine the effect of a 12-week structured e-Learning course on the knowledge of pain management among Nigerian undergraduate medical students. METHODS: Prospective, multisite, pre-post study conducted across five medical colleges in Nigeria. Structured modules covering aspects of pain management were delivered on an e-Learning platform. Pre- and post-test self-assessments were carried out in the 12-week duration of the study. User experience questionnaires and qualitative interviews were conducted via instant messaging to evaluate user experiences of the platform. User experience data was analysed using the UEQ Data Analysis Tool and Framework Analysis. RESULTS: A total of 216 of 659 eligible students completed all sections of the e-Learning course. Participant mean age was 23.52 years, with a slight female predominance (55.3%). Across all participants, an increase in median pre- and post-test scores occurred, from 40 to 60 (Z = 11.3, p<0.001, effect size = 1.3), suggestive of increased knowledge acquisition relating to pain management. Participants suggested e-Learning is a valuable approach to delivering pain education alongside identifying factors to address in future iterations. CONCLUSION: e-Learning approaches to pain management education can enhance traditional learning methods and may increase students' knowledge. Future iterations of e-Learning approaches will need to consider facilitating the download of data and content for the platform to increase user uptake and engagement. The platform was piloted as an optional adjunct to existing curricula. Future efforts to advocate and support integration of e-Learning for pain education should be two-fold; both to include pain education in the curricula of medical colleges across Nigeria and the use of e-Learning approaches to enhance teaching where feasible.

Pott's disease with extensive bilateral psoas abscesses in a Nigerian woman: an unusual case.

Bilateral psoas abscesses are uncommon in Pott's disease. We describe a 28-year-old Nigerian woman with a 2-year history of constitutional symptoms and a 1-year history of bilateral paravertebral masses. She had received anti-tuberculosis (TB) treatment in an interrupted manner. A computed tomography (CT) scan revealed T10-T12 spondylitis, wedge collapse and extensive bilateral psoas abscesses. Histology of the abscess wall was definitively diagnosed as soft tissue TB, and special staining for acid-fast bacilli was positive. She was successfully treated with anti-TB therapy and ultrasound-guided surgical drainage of 6 L of abscess fluid. Complicated cases of Pott's disease may require multi-disciplinary interventions for optimal outcome.

Magnetic resonance imaging in chronic headache: our experiences and perspectives.

BACKGROUND: Headache is a common symptomatology necessitating hospital consultations. Despite the prohibitive cost to patients in Nigeria, Magnetic resonance imaging (MRI) has become an evaluating tool for headache. OBJECTIVES: To determine the yield of cranial MRI and frequency of significant intracranial lesions among patients with chronic headache. METHODS: A three-year retrospective analysis of cranial MR images and records of patients referred to Medicaid Diagnostic Centre in Abuja, Nigeria on account of chronic headache was done. Data was analyzed using SAS software version 9.3. RESULTS: 150 patients aged 9 to 73 years (mean= 39.5 years) with chronic headache were studied. There were 54 males and 96 females with a ratio of 1:1.8. 48% and 52% had normal and abnormal MRI findings respectively. Although the number with abnormal MRI was higher than those with normal exams, this difference was not significant (p=0.624). The commonest neoplastic and non-neoplastic abnormalities were pituitary macroadenoma (4%) and sinusitis (21.3%) respectively. CONCLUSION: In our study, MRI had a low diagnostic yield in patients with chronic headache. Therefore, it is expedient that physicians stratify patients with chronic headache based on red flag signs to determine the need for cranial MRI in view of financial burden.

Low-cost antimicrobial fortification of ultrasound coupling gel: An ergonomic innovation to combat sonology-acquired nosocomial infections.

Background: Recent outbreaks of highly contagious diseases have prompted hospital departments to adopt preventive hygiene protocols. Use of shared equipment, including ultrasound transducers and coupling gels, potentially exposes patients to these microbes. Inexpensive means of microbicide fortification of plain/non-sterile ultrasound gel may be useful in interrupting nosocomial infections. The purpose of this study was to evaluate the effectiveness of low-cost antimicrobial fortification of ultrasound coupling gel in preventing nosocomial infections during ultrasound examinations. Methods: Volunteer patients, 20 in number, who presented for an ultrasound scan in a busy radiology clinic in Enugu, Nigeria, were randomly divided into 2 groups of 10 each and were scanned using plain non-sterile gel and gel-fortified with 0.5% chlorhexidine and 70% ethyl alcohol (in a volume ratio of 20:2:1) respectively. Swabs were taken from the patients' skin, gel-laden transducer, and the cleaned transducer and subjected to microbiology analysis. Subsequently, plain and fortified gel samples were allowed to stand in their respective dispensers for 72 hours. The plain and fortified gel samples were subjected to microbiology analysis. Fisher's Exact Test was utilised to compare outcomes in the 2 groups of volunteers. Results: With fortified gel, swab cultures from patients' skin and gel-laden transducer, and from the cleaned transducer, significantly yielded no growth (P= <0.0001 and P= 0.0001 respectively) while swab cultures from the plain gel yielded a total of 19 microbial isolates from 5 micro-organisms. Conclusion: Low-cost fortification of ultrasound coupling gel with 0.5% chlorhexidine and 70% ethyl alcohol renders it hostile to microorganisms encountered at sonology thus preventing nosocomial transmission.

Impact of physical exercises on immune function, bone mineral density, and quality of life in people living with HIV/AIDS: a systematic review with meta-analysis.

BACKGROUND: Compromised immune function, associated with human immune deficiency virus(HIV) infection, is improved by antiretroviral therapy(ART) which also decreases bone mineral density(BMD), and possibly the quality of life(QoL). However, physical(aerobic/resistance) exercises, were reported to induce reverse effects in uninfected individuals and were appraised in the literature for evidence of similar benefits in people living with HIV/AIDS(PLWHA). The main study objective was to evaluate the impact of physical (aerobic and resistance) exercises on CD4+ count, BMD and QoL in PLWHA. METHODS: A systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to June 2017, only randomized control trials investigating the effects of either aerobic, resistance or a combination of both exercise types with a control/other intervention(s) for a period of at least 4 weeks among adults living with HIV, were included. Two independent reviewers determined the eligibility of the studies. Data were extracted and risk of bias(ROB) was assessed with the Cochrane Collaboration ROB tool. Meta-analyses were conducted using random effect models using the Review Manager(RevMan) computer software. RESULTS: Nineteen studies met inclusion criteria(n = 491 participants at study completion) comprising male and female with age range 22-66 years. Two meta-analyses across 13 sub-group comparisons were performed. However, there were no RCTs on the impact of physical exercises on BMD in PLWHA. The result showed no significant change in CD4+ count unlike a significant effect of 5.04 point(95%CI:-8.49,-3.74,p = 0.00001) for role activity limitation due to physical health(QoL sub-domain). Overall, the GRADE evidence for this review was of moderate quality. CONCLUSIONS: There was evidence that engaging in moderate intensity aerobic exercises (55-85% Maximum heart rate-MHR), for 30-60 min, two to five times/week for 6-24 weeks significantly improves role activity limitation due to physical health problems, otherwise physical(aerobic or/and resistance) exercises have no significant effects on CD4+ count and other domains of QoL. Also, there is lack of evidence on the impact of exercises on BMD in PLWHA due to the paucity of RCTs. The moderate grade evidence for this review suggests that further research may likely have an important impact on our confidence in the estimate of effects and may change the estimate.

A rare case of cor pulmonale secondary to idiopathic pulmonary fibrosis in Nigeria.

Idiopathic pulmonary fibrosis (IPF) is a rarely reported disease in Nigeria. Cor pulmonale, one of the complications of this type of diffuse parenchymal lung disease is even rarer. The authors present a Nigerian patient with IPF with a classical high-resolution CT features, managed in our centre together with associated problems.