How to avoid fluid overload.

PURPOSE OF REVIEW: This review highlights the recent evidence describing the outcomes associated with fluid overload in critically ill patients and provides an overview of fluid management strategies aimed at preventing fluid overload during the resuscitation of patients with shock. RECENT FINDINGS: Fluid overload is a common complication of fluid resuscitation and is associated with increased hospital costs, morbidity and mortality. SUMMARY: Fluid management goals differ during the resuscitation, optimization, stabilization and evacuation phases of fluid resuscitation. To prevent fluid overload, strategies that reduce excessive fluid infusions and emphasize the removal of accumulated fluids should be implemented.

ICU director data: using data to assess value, inform local change, and relate to the external world.

Improving value within critical care remains a priority because it represents a significant portion of health-care spending, faces high rates of adverse events, and inconsistently delivers evidence-based practices. ICU directors are increasingly required to understand all aspects of the value provided by their units to inform local improvement efforts and relate effectively to external parties. A clear understanding of the overall process of measuring quality and value as well as the strengths, limitations, and potential application of individual metrics is critical to supporting this charge. In this review, we provide a conceptual framework for understanding value metrics, describe an approach to developing a value measurement program, and summarize common metrics to characterize ICU value. We first summarize how ICU value can be represented as a function of outcomes and costs. We expand this equation and relate it to both the classic structure-process-outcome framework for quality assessment and the Institute of Medicine's six aims of health care. We then describe how ICU leaders can develop their own value measurement process by identifying target areas, selecting appropriate measures, acquiring the necessary data, analyzing the data, and disseminating the findings. Within this measurement process, we summarize common metrics that can be used to characterize ICU value. As health care, in general, and critical care, in particular, changes and data become more available, it is increasingly important for ICU leaders to understand how to effectively acquire, evaluate, and apply data to improve the value of care provided to patients.

Transdermal microgels of gentamicin.

Phospholipid-modified solid lipid microparticles (SLMs) of Phospholipon® 90G and 90H encapsulating the hydrophilic drug, gentamicin were produced and loaded into three polymeric hydrogels of Poloxamer 407 and polyacrylic acids (Carbopols® 971P and 974P). The SLMs were characterized by morphology and particle size, drug encapsulation efficiency, thermal properties, pH, and storage stability, whereas the microgels were evaluated for viscosity, spreadability, pH, drug content, and in vitro antimicrobial drug release against five microorganisms (Klebsiella spp., Escherichia coli, Bacillus subtilis, Staphylococcus aureus, and Pseudomonas aeruginosa). Our results generally showed Poloxamer 407 microgels of P90H and P90G as having the most desirable properties in terms of fast antibacterial activity on all tested microorganisms, in vitro diffusion-dependent permeation through rat abdominal skin, spreadability, pH, and viscosity, superior to polyacrylic acids microgels.

Low rate of proteinuria in hypertensives resident in a rural area of Plateau State, Nigeria.

BACKGROUND: Hypertensives are screened for proteinuria largely to detect kidney involvement. In most reports from urban areas, the burden is considerable. We decided to see the scenario in a rural setting with the opportunity presented by our cardiovascular disease (CVD) survey of a rural area in North Central Nigeria. METHODOLOGY: In 2008 we surveyed a rural population in Mangu Local Government area of Plateau State for CVD risk factors using the protocol of the National survey of 1991; slightly modified. One in three subjects was sequentially randomized to have blood and urine examination. Blood tests included glucose, creatinine, uric acid, total and high density lipoprotein cholesterol. Blood pressures were also taken. RESULTS: Blood and urine tests were done on 282 subjects. Eight of them (2.84%) had proteinuria. Ninety-nine of the 282 (35.11%) were hypertensive. Seven out of the 99 hypertensives (7.07%) had proteinuria. Between those hypertensives (positive or negative for proteinuria), the following indices: glucose, HDL cholesterol, SBP and DBP differed significantly (p = 0.000, p = 0.015, p = 0.000, p = 0.000 respectively). CONCLUSION: Compared with rates in urban centres of Nigeria, our population recorded low proteinuria rates both for the whole population and the hypertensive segment. It therefore appears that proteinuria in hypertension is not only a reflection of severity and burden of hypertension, but has some relation with residence. Rural areas have lower constellation of CVD risk factor (due to different life style) and lower incidence of hypertension. Consequently, their proteinuria rates are low.

Cardiovascular epidemiological transition in a rural habitat of Nigeria: the case of mangu local government area.

BACKGROUND: Epidemiological transition is at various stages in different places. The true situation in sub-Saharan Africa (SSA) is largely unknown. Having studied this rural habitat 17 years ago, we returned there to study several cardiovascular disease (CVD) risk factors to see if any change had occurred. METHODS: The communities studied in 1991 as part of the national CVD survey were returned to in 2008 and re-studied descriptively in a cross-sectional manner. All adults 15 years and above, apart from demographic and personal data had blood pressure (BP) and some blood indices determined. RESULTS: Over the period, some changes occurred. The mean (SD) age increased from 34.1(16.9) to 45.5(18.2) years suggesting an ageing population. More people in 2008 than 1991 lived most of their last 5 years in the urban areas suggesting some influence of urbanisation. Significantly fewer people smoked and drank after 17 years. However mean (SD) of Body Mass Index rose [20.7(2.8) to 23.7(4.5) kg/m²], as well as SBP and DBP. Prevalence of hypertension rose from 7.4% to 20.9%. Both total and HDL cholesterol rose, although atherogenic index dropped. Mean (SD) blood sugar interestingly dropped from 5.0(2.9) to 4.6(1.0) mmol/l. CONCLUSION: Epidemiological transition is evident in this rural SSA habitat, and proactive steps to stem the tide and curb the consequences of CVD should be instituted.

Prevalence of urinary schistosomiasis in school-aged children in Langai, Plateau State: pre- and post-intervention.

BACKGROUND: Schistosomiasis poses a public health challenges, but for several reasons it is not considered a priority in national and local health policies and programmes. The objective of this study was to determine the effect of health education and drug treatment on the prevalence of Urinary Schistosomiasis among school-aged children in Langai community of Plateau state. METHODS: Two hundred and eighteen children (218) subjects who were selected by multi-staged sampling methods were administered semi-structured questionnaires and their urine samples were assayed for S. haematobium ova using the sedimentation method before and after drug treatment with Praziquantel tablets RESULTS: Pre-intervention, fourteen (14) respondent had urinary Schistosomiasis, giving a prevalence of 6.4% with males (64.3%) having the higher prevalence both pre- and post-intervention. Six weeks after intervention, prevalence had reduced to 0.9%, giving a cure rate of about 92%. Of the 22 respondents (10.1%) who had ever noticed 'blood in their urine', only 6 (27.3%) had Schistosoma ova present in their urine samples at the time of the study. CONCLUSION: It was concluded that drug treatment with Praziquantel, especially when combined with Health Education was effective in reducing the prevalence of Urinary Schistosomiasis among school-aged children in Langai Community of Plateau State.

Impact of hypertension on sexual function in women.

BACKGROUND: the effect of hypertension and its treatment on female sexual function is largely unexplored especially in Africa. However in practice, cases abound where consequent sexual dysfunction leads to poor or non-adherence with catastrophic results. Believing that like in males, hypertension and its treatment should affect female sexual function; we set out using a structured questionnaire to study the subject as it affects women. OBJECTIVE: to examine the relationship between hypertension and female sexual functions of arousal, lubrication and orgasm. METHODS: five hundred questionnaires were distributed to consenting Nigerian women after ethical clearance was obtained. Information sought included demographics, menstrual history, medical treatment and sexual function. RESULTS: a total of 454 returned questionnaires were analysable. Out of this, 109(24%) admitted to being hypertensive, 89 of whom were on treatment. Hypertension was related to difficulty with sustaining sexual excitement (p=0.03), decreased sexual thoughts (p=0.003), poor rating of marriages (p=0.03), difficulty being excited by fantasies (p=0.0001), increased vaginal dryness in the preceding one year (p=0.02), reduced frequency of sexual contact in the last one year (p=0.04) and rejection of partner sexual advance (p=0.05). The proportion of women in regular sexual relationship was less among the hypertensive group (p=0.02). Use of drugs produced significant sexual unpleasantness (p=0.03). CONCLUSION: hypertension and its treatment may produce female sexual dysfunction, and should be considered in managing the female hypertensive. By so doing, quality of life can be maintained; and compliance improved upon. The cumulative effect would be improvement in blood pressure control, with its attendant reduction in morbidity and mortality from hypertension.

Knowledge and treatment practices of malaria among mothers and caregivers of children in an urban slum in Jos, Nigeria.

BACKGROUND: Malaria is a public health problem in more than 90 countries, inhabited by a total of 2.4 billion people, representing about 40% of the world's population. Major trends over the last few decades point to a worsening situation if effective action is not taken. Sadly, this is in spite of enormous efforts and resources that have been invested in its control. The objective of this study was to describe the level of knowledge of malaria as a disease and the practice of its treatment by mothers and caregivers of under five children in Gangare, an urban slum of Jos City, Nigeria. METHODOLOGY: A cross-sectional descriptive study design, a cluster sampling technique and an interviewer administered questionnaire were used to collect information on socio demographic profiles as well as knowledge and treatment practices of malaria from mothers and caregivers of under five children in Gangare, Jos North Local Government Area of Plateau State, central Nigeria. The data was then analyzed using Epi info2002 epidemiological software. RESULTS: The study revealed a low level of knowledge of malaria with 248 (49.6%) being able to recognize the disease and only 124 (24.9%) attributing it to the mosquito bite. The attitude of most respondents towards malaria as an illness was however good as 275 (55%) viewed it as a very serious illness and most of them 328 (65.6%) would use hospitals/clinics for treatment. Majority of them; 462 (92.4%) have not heard of Artemisinin Combination Therapy (ACT) and only 19 (50%) of those who had heard of ACT had ever used it for the treatment of malaria. Generally their knowledge of malaria and treatment seeking practice are influenced by cost of treatment, perceived safety and level of their education. (p < 0.05). CONCLUSION: Among mothers and caregivers living in slums in Jos, their ability to recognize malaria is poor. So also is their awareness and use of Artemisinin Combination Therapy. An improvement in their level of education and their economic power could improve their knowledge and treatment practices.

Knowledge and Treatment Practices of Malaria among Mothers and Caregivers of Children in an Urban Slum in Jos; Nigeria

A cross-sectional descriptive study design; a cluster sampling technique and an interviewer administered questionnaire were used to collect information on socio demographic profiles as well as knowledge and treatment practices of malaria from mothers and caregivers of underfive children in Gangare; Jos North Local Government Area of Plateau State;central Nigeria. The data was then analyzed using Epi info2002 epidemiological software. The study revealed a low level of knowledge ofmalaria with 248(49.6) being able to recognize the disease and only 124(24.9) attributing it to the mosquito bite. The attitude of most respondents towards malaria as an illness was however good as 275(55) viewed it as a very serious illness and most of them 328(65.6) woulduse hospitals/clinics for treatment. Majority of them; 462(92.4) have not heard of Artemisinin Combination Therapy (ACT) and only 19(50) of those who had heard of ACT had ever used it for the treatment of malaria.Generally; their knowledge of malaria and treatment seeking practice are influenced by cost of treatment; perceived safety and level of their education. (p

The impact of advocacy and community mobilization on the utilization of health services at the Comprehensive Health Centre, Gindiri

Primary Health Care facilities provide promotive; preventive; curative and rehabilitative services to a community. They may be well built and equipped with adequate resources but grossly underutilized due to several factors. Health records at the Comprehensive Health Centre Gindiri for 2005 were compared with those of 2007 after a well-coordinated advocacy and mobilization programme in that community. The results show that the total out patient attendance in 2007 increased by 220.6 when compared to that of 2005. 293 patients were admitted into the wards in 2005 compared to 813 in 2007(277). There was no surgery carried out in the whole of 2005; whereas in 2007 there were 98 surgeries. Advocacy and community mobilization could be important factors in the utilization of primary health services

Impact of health education on sexual risk behaviour of secondary school students in Jos, Nigeria.

BACKGROUND: Secondary school students are a high risk group for HIV transmission. They could also be easily reached with health education interventions. There is as yet no global consensus on the nature, content and effectiveness of this intervention among this group. It is also not known how effective this intervention is in reducing sexual risk behaviour among secondary school students in our environment. The aim of the study was to find out the impact of HIV/AIDS health education intervention on the sexual risk behaviour of secondary school students. METHODS: This was an interventional follow-up study among senior secondary school students with controls selected from similar schools. The students' sexual risk behaviour was assessed at baseline followed by a HIV/AIDS health education intervention. The risk behaviour was then re-assessed 6 months after the intervention. RESULT: Students who lived in urban areas and those who lived with both parents were less likely to have experienced sexual intercourse at baseline than those who lived in the rural areas (but school in Jos during school sessions), and those who lived with single parents and other relations. Health education delayed sexual debut among students who were sexually naïve but had no effect on the sexual activity of those who were already sexually experienced. CONCLUSION: Health Education intervention has a place in reducing secondary school students' sexual risk behaviourif commenced before their sexual debut.

Prevalence of premenstrual syndrome and its relationship with blood pressure in young adult females.

Premenstrual syndrome is a collection of symptoms which women experience 1 to 2 weeks before menstruation which clear with onset of menstrual flow and capable of interfering with life functions. An association between Premenstrual syndrome and hypertension has been suggested leading to the suspicion that it may be one precussor trait of hypertension in the normal population. Since people who develop hypertension later in life start from the higher range of normal earlier on, we sought to find if premenstrual syndrome had any bearing on hypertension. Consenting female subjects in three institutions in Jos, Nigeria were studied. Self-administered questionnaires designed to diagnose premenstrual syndrome and anxio-depressive status were used. Medical, family and menstrual history, as well as height, weight, pulse and blood pressures were documented; and data analysed. Four hundred and fourty seven subjects aged between 17 and 38 years with a mean of 23.6 + 3.9 were studied. Sixty one percent of them satisfied the criteria for diagnosis of premenstrual syndrome. When the data for those in luteal phase was split into the early (1st) and late (2nd) parts, there was a statistically significant rise in systolic and diastolic blood pressure from 1st to 2nd parts only for those with premenstrual syndrome (SBP 107.3 + 11.05 to 111.39 + 13.48 mm Hg. p=0.05 and DBP 65.06 + 10.38 to 70.69 + 10.03. p=0.004). Those with premenstrual syndrome also had higher anxiety and depression scores (chi-square 47.9 and 28.4 respectively). The symptoms of premenstrual syndrome peak in the 2nd part of the luteal phase. They are associated with a lot of stress. Since blood pressure elevation with this change was significantly higher among subjects with premenstrual syndrome, it is felt that premenstrual syndrome may predict future hypertension among currently normotensive females.

Impact of health education on sexual risk behaviour of secondary school students in Jos, Nigeria

BACKGROUND:Secondary school students are a high risk group for HIV transmission. They could also be easily reached with health education interventions. There is as yet no global consensus on the nature, content and effectiveness of this intervention among this group. It is also not known how effective this intervention is in reducing sexual risk behaviour among secondary school students in our environment. The aim of the study was to find out the impact of HIV/AIDS health education intervention on the sexual risk behaviour of secondary school students.METHODS:This was an interventional follow-up study among senior secondary school students with controls selected from similar schools. The students' sexual risk behaviour was assessed at baseline followed by a HIV/AIDS health education intervention. The risk behaviour was then re-assessed 6 months after the intervention.RESULT: Students who lived in urban areas and those who lived with both parents were less likely to have experienced sexual intercourse at baseline than those who lived in the rural areas (but school in Jos during school sessions), and those who lived with single parents and other relations. Health education delayed sexual debut among students who were sexually naïve but had no effect on the sexual activity of those who were already sexually experienced.CONCLUSION:Health Education intervention has a place in reducing secondary school students' sexual risk behaviourif commenced before their sexual debut

Awareness of Essential Drug Revolving Fund (EDRF) among Doctors in Jos University Teaching Hospital

Background: There is a need to utilize the available resources in an efficient; cost effective way to meet the needs of patients. The objective of this study was to determine the awareness among doctors in Jos University Teaching Hospital of the Essential Drug Revolving Fund (EDRF). Methods: This is a cross sectional study using a stratified sampling method to enroll doctors from different specialties in the hospital into the study Results: Among the doctors forty-five (46.2) had practiced in Jos University Teaching Hospital for more than twelve months and fifty-five (53.8) for twelve months or less. Only forty-two (41.2) doctors could define Essential Drug Revolving Fund. Eighty-five (83.3) could state correctly the purpose of Essential Drug Revolving Fund. Only two (2.0) knew when Essential Drug Revolving Fund started in Jos University Teaching Hospital; with sixty-one (59.8) correctly defining essential drugs. Sixty-four (62.7) knew the purpose of Essential Drug Revolving Fund and fiftyfive (53.9) knew the existence of an Essential Drug Revolving Fund Committee in Jos University Teaching Hospital. Only forty-three (42.2) knew the criteria for essential drug selection with forty-four (43.1) knowing how they are selected. Though seventy (68.6) knew about rational drug use; only forty-four (43.1) knew how essential drugs are procured. Ninety-three (91.2) knew the definition of polypharmacy; but only twenty-six (25.5) knew how these drugs are stored and stocked. Only thirty-eight (37.3) knew that exempted patients are not part of the scheme in Jos University Teaching Hospital. Conclusion: This study highlights the need for efforts to increase the awareness of doctors on Essential Drug Revolving Fund

In vitro susceptibility testing of dermatophytes isolated from pediatric cases in Nigeria against five antifungals.

The antifungal activities of itraconazole, ketoconazole, fluconazole, terbinafine and griseofulvin were tested by broth microdilution methods against 71 isolates of dermatophytes isolated from Nigerian children. Most drugs were very active against all the dermatophytes and the MIC 90 ranged from 0.03 to 8.0 microg/mL. This appears to be the first documented data on the antifungal susceptibility testing of isolates of dermatophytes from Nigerian children.

Current knowledge and practice of exclusive breastfeeding among mothers in Jos, Nigeria.

BACKGROUND: Exclusive Breastfeeding has been recommended the world over as the optimal feeding mode for young infants. A cross sectional study to determine the current level of knowledge and practice of nursing mothers on exclusive breastfeeding in Jos was carried out. METHODS: The target population of interest was nursing mothers who have infants aged 6-12 months in Jos, a cosmopolitan city in the north central zone of Nigeria. A pre-tested, structured close ended interviewer questionnaire was used. Four hundred and seventy nursing mothers who consented were recruited for the study through a house-to-house visit. Three assistants (two females and a male) were recruited and trained on the questionnaire administration. Data analysis was by SPSS software and chi-square test of proportion for statistical significance of association was done. RESULTS: Out of the 470 nursing mothers studied 387 (82.3%) were able to define correctly exclusive breastfeeding while 315 (67.0%) practiced or were practicing exclusive breastfeeding at the time of this study. The knowledge and practice of exclusive breastfeeding was found to increase with increasing age and better educational status of the women. Ninety six (20.4%) nursing mothers said they never breastfed their babies while in public place. CONCLUSION: Although knowledge and practice of exclusive breastfeeding among the women were considerably high, the younger age brackets were less knowledgeable arid adherent to the practice. Targeting adolescents for exclusive breastfeeding education and sensitization is necessary in preparing them for motherhood.

In vitro susceptibility testing of dermatophytes isolated from pediatric cases in Nigeria against five antifungals

The antifungal activities of itraconazole, ketoconazole, fluconazole, terbinafine and griseofulvin were tested by broth microdilution methods against 71 isolates of dermatophytes isolated from Nigerian children. Most drugs were very active against all the dermatophytes and the MIC 90 ranged from 0.03 to 8.0 µg/mL. This appears to be the first documented data on the antifungal susceptibility testing of isolates of dermatophytes from Nigerian children.

Atividades antifúngicas de itraconazole, ketoconazole, fluconazole, terbinafine e griseofulvina foram testadas por métodos de microdiluição em caldo contra 71 isolados de dermatófitos de crianças nigerianas. A maioria das drogas foi muito ativa contra todos os dermatófitos e o MIC 90 variou de 0,03 a 8,0 µg/mL. Estes parecem ser os primeiros dados documentados sobre os testes de susceptibilidade antifúngica de isolados de dermatófitos de crianças nigerianas.

Knowledge, attitude and practice of health workers in Keffi local government hospitals regarding Baby-Friendly Hospital Initiative (BFHI) practices.

OBJECTIVE: To assess the knowledge, attitude and practice of health workers towards Baby Friendly Hospital Initiative (BFHI) practices and thereafter plan an advocacy on BFHI training of the workers. DESIGN: A randomised cross-sectional study. SETING: Ten out of 16 health facilities reflecting all the levels of healthcare provision in Keffi Local Government Area in Nassarawa State, Nigeria, were selected. Staff of these health facilities had not received BFHI training, although breastfeeding is the norm in this population, exclusive breastfeeding is almost zero. SUBJECTS: A total of 250 health workers (six doctors, 160 nurses and 84 auxiliary staff) met in the health facilities at the time of interview. INTERVENTION: A structured questionnaire based on 10 steps to successful breastfeeding was administered by one of the authors and a Lactad nurse between July and October 1995. RESULTS: Fifty-two (20.8%) were aware of the need for initiating breastfeeding within 30 min of birth and 92 (36.8%) were aware of breastfeeding support groups. However, there were significant differences in the level of awareness among the doctors compared to the other categories of health staff (P<0.05). Also, 48 (19.2%) of the health workers believed that babies less than 6 months of age should not be given water (statistical difference (P<0.05) between doctors' attitude and that of the other health workers). Thirteen (5.22%) health workers could demonstrate correct positioning and attachment. CONCLUSION: There was general lack of awareness of some major recommended practices in the hospitals that will promote and sustain breastfeeding. There is therefore the need for policy changes and BFHI training for the staff of these health facilities to respond to the concern and growing need for proper infant/young child feeding.