Metabolic Syndrome and Atherosclerotic Cardiovascular Risk in a Population Of Market Women in a Semi-Urban Town, South-West Nigeria.

BACKGROUND: Metabolic Syndrome (MS) is a non-communicable disease of global significance. The presence of MS denotes increased risk of cardiovascular disease. The global prevalence of MS is on the increase because of lifestyle changes like consumption of high calorie, low fibre foods coupled with reduced physical activity OBJECTIVES: To determine the prevalence of MS and its components and to estimate atherosclerotic cardiovascular disease (ASCVD) risk in a population of market women. METHODS: A cross-sectional, observational study among female traders in a market in South-western Nigeria. MS was determined using the harmonized NCEP-ATPIII and IDF criteria. The ASCVD risk estimator by the American College of Cardiologists and American Heart Association was used to assess ASCVD risk. RESULTS: One hundred and sixty-nine female traders aged 23 to 80 years with a mean age of 52.8±13.2 years were involved in the study. Overweight and obesity were seen in 61 (36.5%) and 57 (34.1%) participants respectively. Prevalence of MS was 34.9% and the most frequent components of MS were hypertension (62.1%), low HDL-cholesterol (53.8%) and elevated serum triglycerides (18.3%). MS was associated with increasing age (p= 0.010) and BMI (p= 0.009). Significant 10-year ASCVD risk was found in 63 (52.1%) out of 121 participants eligible for ASCVD risk estimation. Significant 10-year ASCVD risk was found in 33(67%) out of 59 participants with MS. CONCLUSION: This study demonstrated significant risk for cardiovascular disease in a population of market women. A more active lifestyle, appropriate diet and treatment of hypertension, diabetes and dyslipidaemia should be encouraged.

Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February-6 June 2020.

The objective of this study was to describe the epidemiology of COVID-19 in Nigeria with a view of generating evidence to enhance planning and response strategies. A national surveillance dataset between 27 February and 6 June 2020 was retrospectively analysed, with confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR). The primary outcomes were cumulative incidence (CI) and case fatality (CF). A total of 40 926 persons (67% of total 60 839) had complete records of RT-PCR test across 35 states and the Federal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19 cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinical outcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were 5.6 per 100 000 population and 2.8%, respectively. The highest proportion of COVID-19 cases and deaths were recorded in persons aged 31-40 years (25.5%) and 61-70 years (26.6%), respectively; and males accounted for a higher proportion of confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmed COVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper has provided an insight into the early epidemiology of COVID-19 in Nigeria, which could be useful for contextualising public health planning.

Study of association between sickle cell trait and renal dysfunction among young adults in South-west Nigeria.

BACKGROUND: Although sickle cell disease has become a recognized etiology of chronic kidney disease (CKD), the sickle cell trait (SCT) variant was until recently believed to be a benign carrier state with little or no effect on the health of affected individuals. However, recent studies now appear to suggest an association between SCT and CKD. OBJECTIVE: The objective of the study is to determine the association between SCT (hemoglobin AS) and renal dysfunction among young Nigerian adults. METHODOLOGY: This was a cross-sectional, descriptive study among apparently healthy undergraduates of Adeyemi College of Education, Ondo, southwest Nigeria. Their hemoglobin genotypes were determined using standard alkaline electrophoresis; their blood pressure, anthropometry, serum total cholesterol (TC), creatinine, and estimated glomerular filtration rate (eGFR) were determined. Data analyzed using Statistical Package for Social Sciences (SPSS) 20 were significant at P < 0.05. RESULTS: Six hundred and two subjects with HbAS (SCT, n = 465) and HbAA (non-SCT, n = 137) were studied. Their age range was 18-30 years with male-to-female ratio 1:3.8. There was no difference in the prevalence of renal dysfunction between SCT and non-SCT subjects (5.1% vs. 5.2%, P = 0.591). There was no increased risk of CKD among subjects with SCT (PR, 0.99 at 95% CI [0.417-2.348]). CONCLUSION: SCT was not associated with increased risk of renal dysfunction among young adults in Nigeria. Further studies are needed to clarify the controversy, especially in Nigeria, with a relatively higher prevalence of SCT.

Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study.

Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams.

Missing an opportunity: the embedded nature of weight management in primary care.

The 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care. The objective of this portion of the study was to explore how primary care providers incorporate weight management in their practice. 5AsT is a randomized controlled trial (RCT) on the implementation of a 6-month 5 As Team (5AsT) intervention designed to operationalize the 5As of obesity management in primary care. Data for the qualitative portion of the study presented here included semi-structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions. Thematic analysis was undertaken. A key pattern that emerged from the data was that healthcare providers usually do not address obesity as a primary focus for a visit. Rather, obesity is embedded in a wide range of primary care encounters for other conditions. Implications were it can take extra time to discuss weight, it can be inappropriate to bring up weight as a topic, and treating risk factors and root causes of obesity have indirect benefits to patient weight management. Our findings have implications for obesity treatment approaches and tools that assume a discreet weight management visit. The embedded nature of obesity management in primary care can be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals.

5As Team obesity intervention in primary care: development and evaluation of shared decision-making weight management tools.

Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co-developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation-oriented, need-based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co-developed with 5AsT. All tools were evaluated as either 'most useful' or 'moderately useful' in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision-making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice.

Six-year changes in body mass index and cardiorespiratory fitness of English schoolchildren from an affluent area.

We compared values of body mass index (BMI) and cardiorespiratory fitness (20 m shuttle-run test) of n=157 boys and n=150 girls aged 10-11 measured in 2014 with measures from 2008 and 1998. Boys' fitness was lower (d=0.68) in 2014 than 2008, despite a small (d=0.37) decline in BMI. Girl's BMI changed trivially (d=0.08) but cardiorespiratory fitness was lower (d=0.47) in 2014 than 2008. This study suggests fitness is declining at 0.95% per year, which exceeds the 0.8% rate of decline we reported between 1998 and 2008 and is double the global average of 0.43%. Declines in fitness were independent of changes in BMI suggesting continued reductions in English children's habitual physical activity levels.

Athletic performance and birth month: is the relative age effect more than just selection bias?

The aim of this study was to determine if month of birth affects performance in 3 tests of physical function in children and adolescents. We measured cardiorespiratory fitness, handgrip strength and lower-body power expressed them relative to (whole year) age then compared scores between calendar year birth-months. We also expressed test performance as the likelihood of achieving criterion-referenced fitness standards. There were significant main effects of birth-month for cardiorespiratory fitness (F=4.54, p<0.001), strength (F=6.81, p<0.001) and power (F=3.67, p<0.001). Children born in November were fitter and more powerful than those born at other times, particularly the summer months (April, May and June). October-born children were stronger than those born in all months except September and November. This relationship was evident despite controlling for decimal age and despite no significant inter-month differences in anthropometric characteristics.There is a clear physical advantage for those born in the autumn and this may explain some of the bias in sports selection attributed to the relative age effect, particularly when the British school-year (September) cut-off is used.

Metabolic risk profile of schoolchildren and joint physical activity with an adult in the household: multilevel analysis.

We aim to examine the relationship between metabolic risk (MR) profile and physical activity (PA) with an adult within the household. A total of 4761 schoolchildren (54% boys) aged 10-16 years old were categorized as either at high MR or low MR profile based on their weight and systolic blood pressure status. We assessed the frequency of PA with an adult within the household and fitness. Multilevel regressions were used to determine the likelihood of being at MR in schoolchildren. The proportion of males and females who engage in PA with adults daily was 17.4% and 10.4%, respectively. 16.5% male and 17.2% female did not engage in any PA with adults at all. Compared with those engaging in PA daily with adults in their household, schoolchildren who have reported no such PA were 54% (OR 1.54, 95% CI, 1.07-2.20) likely to have an elevated MR profile. Those who sometimes do PA with adult were 25% (OR 1.25, 95% CI, 0.82-1.93) more likely to have a higher MR profile. After adjusting for PA and fitness, PA with adults remains a determinant of MR profile in males. Compared with those that reported they daily did, schoolchildren were more likely to be unfit if they either sometimes engaged in PA with adults (OR 2.11, 95% CI, 1.44-3.09) or never (OR 2.89, 95% CI, 1.89-4.43). Joint PA with an adult within household could increase schoolchildren's fitness level and may reduce the risk of metabolic diseases.

Temporal relationships between screen-time and physical activity with cardiorespiratory fitness in English schoolchildren: a 2-year longitudinal study.

OBJECTIVE: To determine the temporal relationships screen-time and physical activity have with cardiorespiratory fitness. METHOD: Measures were made over two years (2008-2010) in 1500 participants aged 11.5 (SD 0.5) years at baseline. RESULTS: Tracking coefficients were low-to-moderate for all measures. At follow-up, 25% of participants moved from having low (<2h) to high (≥ 2 h) daily screen-time and 6% became unfit according to FITNESSGRAM standards. Baseline screen-time was the strongest univariate predictor of becoming unfit. Multivariate analysis controlling for decimal age, BMI and deprivation confirmed baseline screen-time as the strongest independent predictor of becoming unfit over the 2-year study period (OR 2.4; 95%CI:1.4-4.0). Current (OR 2.3; 95%CI:1.3-4.0) and previous (OR 1.7; 95%CI:1.0-2.9) physical activity levels also independently predicted becoming unfit. CONCLUSION: There is currently no guidance for limiting screen-time in UK children. These longitudinal data add to the cross-sectional evidence of lower physical activity and fitness in children reporting ≥ 2 h daily screen-time. More importantly, these data demonstrate that high screen-time during childhood is an independent predictor of lower cardiorespiratory fitness in adolescence.

Prevalence of high screen time in English youth: association with deprivation and physical activity.

BACKGROUND: Physical activity (PA) and deprivation are major determinants of health. We estimated the prevalence of high screen time (ST) among English youth and examined whether deprivation mediated the relationship between ST and PA. METHODS: It is a cross-sectional study of 6240 participants (53% boys, aged 10-15 years) enrolled in the East of England Healthy Hearts study. The participants were categorized into three groups based on daily ST: <2, 2-4 or >4 h. Participants were classified as 'active' or 'inactive' based on PA z-scores. RESULTS: Prevalence of >2 h ST was 36%. Participants reporting <2 h daily ST were more likely to be active than those reporting 2-4 h (adjusted OR: 1.51, 95% CI: 1.26-1.82, P< 0.001) or >4 h (adjusted OR: 2.26, 95% CI: 1.91-2.67, P< 0.001). Analysis of covariance demonstrated a significant main effect for ST on PA (F = 85.7, P< 0.001) with lower PA in each ascending ST group (P< 0.001). Deprivation was not significantly associated with PA and did not mediate the relationship between ST and PA. CONCLUSIONS: There is high prevalence of >2 h ST in English schoolchildren. PA is lower in children reporting 2-4 versus <2 h daily ST and lower still in those classified as heavy users (>4 h) independent of deprivation.

Contrasting physical activity patterns in children and adolescents living in differing environments in the U.K.

AIMS: There is evidence for lower physical activity (PA) in rural adults; it is important to evaluate how the environment influences the PA of children and adolescents. METHODS: We compared the PA of 6485 English 10-15.9 year olds according to two systems for classifying the immediate environment. System one compared urban and rural areas. System two compared urban, town and fringe, and rural areas. Analyses were carried out separately for children (<13 years) and adolescents (>13 years). RESULTS: Rural children were more active than those from urban areas (OR 1.38, 95% CI 1.15-1.66) as were adolescents (OR 1.30, 95% CI 1.11-1.51). Using trilateral division, children were more active if they lived in town and fringe (OR 1.32, 95% CI 1.03-1.67) or rural (OR 1.45, 95% CI 1.14-1.84) areas compared with urban areas. Adolescents from town and fringe areas were more active than urban dwellers (OR 1.50, 95% CI 1.24-1.81). Rural adolescents' PA did not differ from urban dwellers'. CONCLUSIONS: Rural environments support PA in children but not that of adolescents. Town and fringe areas with mixed elements of rural and urban land use appear to facilitate and sustain PA in both children and adolescents.

A cohort study of the risk of cancer associated with type 2 diabetes.

BACKGROUND: There is evidence to suggest that diabetes may increase the risk of incidence and mortality from cancer. METHODS: In a cohort study using record-linkage health-care datasets for Tayside, Scotland in 1993-2004, we followed up 9577 newly diagnosed patients with type 2 diabetes, and two matched non-diabetic comparators, in the national cancer register. RESULTS AND CONCLUSIONS: The risk ratio for any cancer, adjusted for deprivation, was 0.99 (95%CI 0.90-1.09). Significantly increased risks were observed for pancreatic, liver and colon cancer.

Multiple enamel pearls in two siblings detected by volumetric computed tomography.

A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two siblings incidentally recognized during volumetric CT examination. Although the pathogenesis of ectopic enamel formation is not known, possible mechanisms to account for this phenomenon are discussed in the context of current knowledge regarding root genesis. The radiographic presentation of enamel pearls and its clinical significance is also discussed. The observation of multiple enamel pearls in two siblings raises the possibility of a hereditary association in the formation of enamel pearls.

The influence of social support on the duration of breast-feeding among antenatal patients in Ibadan.

In Nigeria, breast-feeding has been shown to be very closely related to infant survival. Prolonged and adequate breast-feeding is critical to most infants' nutritional health and growth. This study aims to determine the influence of family support on the duration of exclusive and total breast-feeding of infants of antenatal patients. This cross-sectional study was conducted between 1 September and 30 December 2005. The tool was a structured questionnaire. The main outcome variables were the duration of breast-feeding; both total and exclusive explanatory variables were mainly related to support obtained during breast-feeding from husband and older female relations. Husbands support significantly increased the total duration of breast-feeding by a mean of 1.69 months (95% CI 0.88, 2.51), however, exclusive breast-feeding was not significantly affected by the husband's support (OR 0.94; 95% CI 0.63, 1.39). Female support had a significant influence on both the total duration of breast-feeding which is increased by a mean of 1.08 months (95% CI 0.14, 2.02), and the adequate conduct of exclusive breast-feeding (OR 1.83; 95% CI 1.17, 2.86). The cultural practice of having additional female support in the postpartum period has been shown by this study to be beneficial. Therefore, this cultural practice should be encouraged and catalogued as a beneficial cultural practice. This practice is also cheap and sustainable.

Reduction of hippocampal CA 1 neurons in Wistar rats following the administration of phenytoin for seven days.

This study evaluated the neurotoxic effect of parenteral Phenytoin on the Cornu Ammonis 1 (CA 1) region of the Hippocampus in Wistar rats.Twenty wistar rats were randomized into two groups of ten animals each with the experimental group receiving intraperitoneal Phenytoin at a dose of 25 mg/kg body weight per day for seven days while the control group had sham injection of normal saline at equivalent volume for the same period. Hippocampal sections were processed for histology using routine paraffin sectioning followed by Heamatoxylin and Eosin staining. There was a statistically significant reduction in the mean body weight of the experimental group compared to the control group. The cell density in the stratum pyramidale (per 0.11 mm2 area of the CA 1 region of the Hippocampus) was reduced in the experimental group when compared to the control group. (P<0.05). The mean brain weight in both groups did not differ significantly. Our findings reveal that the administration of parenteral phenytoin at a dose of 25mg/kg body weight per day for seven days in Wistar rats resulted in reduction of the cell density in the stratum pyramidale of the CA 1 subfield of the Hippocampus in Wistar rats and a reduction in the mean body weight.

Malignant schwannoma of the nasal cavity and paranasal sinuses in a Nigerian.

An unusual case of malignant schwannoma with involvement of the forehead, external nose, right nasal cavity, paranasal sinus system (bilateral frontal sinus, right ethmoidal sinus), right orbit and anterior cranial fossa is reported in a Nigerian. Malignant schwannomas of the paranasal sinus are extremely rare, as only 20 well-documented cases have been previously published in English literature. No report in black Africans has been found in extant literature. The clinical features of this tumour are presented with detailed management. The patient had a wide surgical resection of the lesion with reconstruction of the resultant fronto-nasal defect using forehead musculofascial flap plus full thickness skin graft and adjuvant radiotherapy with satisfactory outcome. The good result of combined surgery and radiation regimens in this case demonstrates the usefulness of adjuvant radiation therapy in this condition.

Presbycusis in Nigerians at the University College Hospital, Ibadan.

Presbycusis refers to sensori-neural hearing impairment in elderly individuals resulting from the degenerative changes of aging. Characteristically, it involves bilateral sensorineural hearing loss, worse at high frequencies, which is associated with difficulty in speech discrimination and central auditory processing of information. The aim of this study is to present our observations on presbycusis as seen in Nigerians. A 41/2-year prospective study of 67 patients that presented with features of presbycusis in the Ear, Nose and Throat Department of the University College Hospital, Ibadan, Nigeria between January 2000 and June 2004 was done. The diagnosis of presbycusis in each subject was based on history, clinical findings, and pure tone audiometry. 67 patients with features of presbycusis were seen and treated over the studied period with 37 males (55.2%), 30 females (44.8%) (M:F 1.2:1) and with an average age of 69.3 years (age range 46-90 years). Presbycusis constituted 2.4% of the 2817 otological cases seen during the studied period. Majority (64.1%) of the cases were of 6th to 8th decades of life. The symptoms were mainly of hearing loss 34 (50.7%), tinnitus 19 (28.4%), hearing loss and tinnitus together in 14 (20.9%) cases. Stria (metabolic) presbycusis 20 (29.9%) constituted the most common type of presbycusis seen in this study followed by mechanical presbycusis 15 (22.4%), neural presbycusis 14 (20.9%) and sensory presbycusis 7 (10.4%) respectively. Presbycusis has been found in this study to affect both males and females subjects almost equally, has an insidious onset as from fourth decades of life in our environment, of stria (metabolic) type mostly, presents with moderate to severe sensori-neural hearing loss (SNHL), and constitute an important problem in the society as it occurs in an elderly population that relies on their special senses (especially auditory) to compensate for other age-associated disabilities.