Insilico evaluation on potential Mt-Sp1/matriptase inhibitors data: DFT and molecular modelling approaches.

Nine heterocyclic compounds were investigated using density functional theory, molecular operating environment software, material studio, swissparam (Swiss drug design) software. In this work, the descriptors generated from the optimized compounds proved to be efficient and explain the level of reactivity of the investigated compound. The developed quantitative structure activity relationship (QSAR) model was predictive and reliable. Also, compound 9 proved to be capable of inhibiting Mt-Sp1/Matriptase (pdb id: 1eax) than other examined heterocyclic compounds. Target prediction analysis was carried out on the compound with highest binding affinity (Compound 9) and the results were reported.

Public risk perception and behaviours towards COVID-19 during the first and second waves in Nigeria: a secondary data analysis.

OBJECTIVES: To describe changes in public risk perception and risky behaviours during the first wave (W1) and second wave (W2) of COVID-19 in Nigeria, associated factors and observed trend of the outbreak. DESIGN: A secondary data analysis of cross-sectional telephone-based surveys conducted during the W1 and W2 of COVID-19 in Nigeria. SETTING: Nigeria. PARTICIPANTS: Data from participants randomly selected from all states in Nigeria. PRIMARY OUTCOME: Risk perception for COVID-19 infection categorised as risk perceived and risk not perceived. SECONDARY OUTCOME: Compliance to public health and social measures (PHSMs) categorised as compliant; non-compliant and indifferent. ANALYSIS: Comparison of frequencies during both waves using χ2 statistic to test for associations. Univariate and multivariate logistic regression analyses helped estimate the unadjusted and adjusted odds of risk perception of oneself contracting COVID-19. Level of statistical significance was set at p<0.05. RESULTS: Triangulated datasets had a total of 6401 respondents, majority (49.5%) aged 25-35 years. Overall, 55.4% and 56.1% perceived themselves to be at risk of COVID-19 infection during the W1 and W2, respectively. A higher proportion of males than females perceived themselves to be at risk during the W1 (60.3% vs 50.3%, p<0.001) and the W2 (58.3% vs 52.6%, p<0.05). Residing in the south-west was associated with not perceiving oneself at risk of COVID-19 infection (W1-AOdds Ratio (AOR) 0.28; 95% CI 0.20 to 0.40; W2-AOR 0.71; 95% CI 0.52 to 0.97). There was significant increase in non-compliance to PHSMs in the W2 compared with W1. Non-compliance rate was higher among individuals who perceived themselves not to be at risk of getting infected (p<0.001). CONCLUSION: Risk communication and community engagement geared towards increasing risk perception of COVID-19 should be implemented, particularly among the identified population groups. This could increase adherence to PHSMs and potentially reduce the burden of COVID-19 in Nigeria.

Prevalence, patterns and predictors of metabolic abnormalities in Nigerian hypertensives with hypertriglyceridemic waist phenotype: A cross sectional study.

BACKGROUND: Simultaneous presence of elevated waist circumference and hypertriglyceridemia (HTGW) is a simple and low-cost measure of visceral obesity, and it is associated with a plethora of cardio-metabolic abnormalities that can increase the risk of cardiovascular diseases and incident Type 2 diabetes mellitus. We decided to study the prevalence, patterns, and predictors of metabolic abnormalities in Nigerian hypertensives with the HTGW phenotype. METHODS: The medical records of 582 hypertensives with complete data of interest were retrieved and analyzed for the study. Their socio-demographic data, anthropometric data, and booking blood pressure values were retrieved. The results of their fasting plasma glucose, lipid profile, uric acid and serum creatinine were also retrieved for analysis. RESULTS: The mean age of the study population was 56.2 ±13.6, with 53.1% being males. The prevalence of smoking and use of alcohol was 4.3% and 26.5% respectively. The prevalence of the HTGW phenotype was 23.4% and were predominantly males (61%). Subjects with the HTGW phenotype were more obese assessed by waist circumference (WC) and body mass index (BMI). Mean serum total cholesterol, triglyceride, very low-density lipoprotein, uric acid, and creatinine were significantly higher in the HTGW phenotype (p = 0.003; <0.001; <0.001; 0.002 and <0.001 respectively). The prevalence of newly diagnosed Type 2 diabetes was 28.7%. There was also a preponderance of cardio-metabolic abnormalities (obesity, dyslipidaemia, hyperuricemia) in the HTGW phenotype. In both males and females, the HGTW phenotype was significantly associated with elevated Tc, TG, VLDL, hyperuricemia and atherogenic index of plasma. CONCLUSION: The HTGW phenotype is common amongst Nigerian hypertensives, and it is associated with metabolic abnormalities.

Opportunistic screening of cardiovascular disease risk factors in community pharmacies in Nigeria: a cross-sectional study.

Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1 years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25 kg/m2) or obese (BMI ≥ 30 kg/m2) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p < 0.001. Using BP > 130/80 mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD.

Correction to: Knowledge of cardiovascular disease risk factors and practice of primary prevention of cardiovascular disease by Community Pharmacists in Nigeria: a cross-sectional study.

The article Knowledge of cardiovascular disease risk factors and practice of primary prevention of cardiovascular disease by Community Pharmacists in Nigeria: a cross-sectional study.

Knowledge of cardiovascular disease risk factors and practice of primary prevention of cardiovascular disease by Community Pharmacists in Nigeria: a cross-sectional study.

Background Studies in international literature have shown that Community Pharmacists can make considerable impact in controlling cardiovascular disease risk factors, especially hypertension. In Nigeria, there are no studies on the knowledge of CVD risk factors by Community Pharmacists and their practice of primary prevention. Objective To assess the knowledge of CVD risk factors and practice of primary prevention of CVD amongst Nigerian community pharmacists. Setting Community Pharmacists in Lagos, Nigeria. Methods This cross-sectional study involved 168 Community Pharmacists. Their knowledge of CVD risk factors was assessed with the Heart Disease Fact Questionnaire. Their opportunistic screening practices for CVD risk factors (primary prevention) were also assessed. Main outcome measures Knowledge of CVD risk factors and practice of primary CVD prevention. Results The mean age of the participating pharmacists was 41.7 (± 11.2) years and 87 (51.8%) of them were males. The median number of years of practice was 9.0 (3-15) years. Mean knowledge score was 22.1 (± 3.0) with 154 (91.7%) of the subjects scoring above 70%. An average of 95.5% of the participants correctly identified hypertension, smoking, dyslipidaemia, obesity, physical inactivity and diabetes as CVD risk factors. Eighty-one (48.2%) had good practice of primary CVD prevention. Conclusion: This study shows that Community Pharmacists in Nigeria have very good knowledge level of CVD risk factors and almost 50% of them practised primary prevention of CVD.

The Fire Service for the Removal of a Metallic Penile Constricting Device: A Ready Help When All Else Fail.

The placement of a constricting device around the penis is a urologic emergency. Though injuries from constricting penile devices are generally rare, they may be associated with serious complications. There is no standard modality for the removal of penile constricting devices and the management of the patient can therefore prove to be a formidable challenge to the urologist. Timely intervention is always important in preventing complications especially penile gangrene. Depending on the type of device used along with the duration and severity of penile constriction caused, significant resourcefulness may be required in the treatment of the patient. Achieving a timely and successful outcome may require a multidisciplinary approach involving equipment only available with the fire service or other agencies. We report the case of a 30-year-old man with a background psychiatric illness who had his penile constricting device removed under conscious sedation in the emergency room with the aid of a power driven arc saw from the fire service with a successful outcome.

The challenges of cardiothoracic surgery practice in Nigeria: a 12 years institutional experience.

BACKGROUND: Although the specialty of cardiothoracic surgery has been practiced in Nigeria for many years, open heart surgery (OHS) has only in the last decade become relatively more frequent, mainly through visiting foreign cardiac surgical teams. At this early phase of development it is faced with multiple challenges, especially financing and local skilled manpower for which solutions have to be identified in order to ensure sustainability and future growth. This study is aimed at highlighting these obstacles to growth of cardiothoracic surgery based on our own institutional experience at Lagos State University Teaching Hospital (LASUTH) and the current status of OHS activity in other cardiothoracic centers in Nigeria. METHODS: Prospectively acquired data from our center from March 2004 to December 2015 was reviewed. A telephone survey was also conducted with all other institutions in Nigeria performing cardiac surgery. RESULTS: During the study period 1,520 patients underwent various procedures with a mean age of 37±22.4 years and 813 (53.5%) were males. There were 450 major procedures (29.6%), 889 minor procedures (58.5%) and 181 endoscopic procedures (11.9%). The top ten clinical diagnoses were empyema thoracis (17.5%), malignant pleural effusion (14.7%), chest trauma (12%), hemodialysis access (6.1%), bradyarrhythmia (5.3%), aerodigestive foreign bodies (4.1%), vascular injury (3.9%), pericardial disease (3.8%), lung cancer (3.6%) and congenital heart disease (3.4%). The range of procedures was chest tube insertion (41.6%), endoscopy (11.9%), lung procedures (7%), arterio-venous fistula (6.1%), pacemaker implantation (5.3%), vascular repair (4.4%), OHS (3.4%), esophageal procedures (2.6%), chest wall surgery (2%), video assisted thoracic surgery (2%), closed heart surgery (1.6%), diaphragmatic procedures (1.6%) and thymectomy (1%). Survey of 15 centers in Nigeria with cardiac surgery activity showed a total of 496 OHS cases between 1974 and 2016, with 330 cases (66.5%) done between 2012 and 2016. CONCLUSIONS: Infections, malignancy and trauma currently account for the bulk of cardiothoracic surgery practice in Nigeria, with surgical activity showing a predominance of minor procedures and comparatively minimal OHS activities. Identified challenges to increasing cardiothoracic surgical activity were limitations in manpower development, infrastructure, laboratory support, local availability of consumables, cost of surgery, funding mechanisms for surgery, multiple models for development of cardiac surgery, decentralization of efforts and lack of outcome data. Data collection and reporting of results must be started to enable development of more evidence-based practice.

Preliminary experience in the management of tracheobronchial foreign bodies in Lagos, Nigeria.

Aspiration of tracheobronchial foreign bodies commonly affects young children, is potentially life threatening and requires early intervention for extraction. Access to facilities and skill manpower for bronchoscopic extraction is however limited in Nigeria. The aim of this study is to describe the experience in our institution with bronchoscopic removal of tracheobronchial foreign bodies and highlight the challenges encountered. This is a retrospective study of all patients referred to the Lagos State University Teaching Hospital with a diagnosis of tracheobronchial foreign body within the period of February 2008 and February 2013. Data extracted from the medical records were age, sex, time interval between aspiration and presentation, location of tracheobronchial foreign body, bronchoscopic technique, complications and outcome. A total of 24 patients were referred and confirmed at bronchoscopy to have tracheobronchial foreign bodies. Mean age was 6.6 + 5 years. Male to female ratio was 1:1. Delayed presentation was common with 22 patients (91.7%) presenting more than 24 hours after aspiration. Aspirated material was inorganic in 17 patients (70.8%) and organic in 7 patients (29.2%). Location of tracheobronchial foreign bodies was right main bronchus in 16 patients (66.7%), left main bronchus in 6 patients (25%) and the trachea in 2 patients (8.3%). Challenges to speedy and safe removal of the foreign bodies were delayed presentation and a limited range of bronchoscopic equipment early in the series which caused prolonged procedures and increased complications. Two mortalities occurred early in the series; one from airway obstruction and the other from respiratory failure caused by tracheobronchial oedema. Extraction of tracheobronchial foreign bodies was faster, more complete and safer later in the series due to a wider range of bronchoscopy equipment which included both flexible and rigid videobronchoscopy with the use of optical forceps. This preliminary experience suggests that an adequate armamentarium of bronchoscopy equipment is required to increase the chances of complete extraction, speed up the procedure and reduce the risk of complications of Tracheobronchial Foreign Bodies in our environment. Delayed presentation increases the difficulty of the procedure so earlier referral of these patients would help reduce the risk involved in their management.

Off pump coronary artery bypass surgery in a Nigerian teaching hospital.

Coronary artery bypass grafting has not been previously reported in the Nigeria medical literature. We report the case performed in our institution of a 56 year old Nigerian female who underwent off pump coronary artery bypass surgery (OPCAB) for an ostial lesion of the left anterior descending coronary artery. The left internal mammary artery was successfully anastomosed to the left anterior descending coronary artery. The patient was discharged home after 2 weeks, following correction of problems with glycemic control.

The cost of open heart surgery in Nigeria.

INTRODUCTION: Open Heart Surgery (OHS) is not commonly practiced in Nigeria and most patients who require OHS are referred abroad. There has recently been a resurgence of interest in establishing OHS services in Nigeria but the cost is unknown. The aim of this study was to determine the direct cost of OHS procedures in Nigeria. METHODS: The study was performed prospectively from November to December 2011. Three concurrent operations were selected as being representative of the scope of surgery offered at our institution. These procedures were Atrial Septal Defect (ASD) Repair, Off Pump Coronary Artery Bypass Grafting (OPCAB) and Mitral Valve Replacement (MVR). Cost categories contributing to direct costs of OHS (Investigations, Drugs, Perfusion, Theatre, Intensive Care, Honorarium and Hospital Stay) were tracked to determine the total direct cost for the 3 selected OHS procedures. RESULTS: ASD repair cost $ 6,230 (Drugs $600, Intensive Care $410, Investigations $955, Perfusion $1080, Theatre $1360, Honorarium $925, Hospital Stay $900). OPCAB cost $8,430 (Drugs $740, Intensive Care $625, Investigations $3,020, Perfusion $915, Theatre $1305, Honorarium $925, Hospital Stay $900). MVR with a bioprosthetic valve cost $11,200 (Drugs $1200, Intensive Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535, Honorarium $925, Hospital Stay $900). CONCLUSION: The direct cost of OHS in Nigeria currently ranges between $6,230 and $11,200. These costs compare favorably with the cost of OHS abroad and can serve as a financial incentive to patients, sponsors and stakeholders to have OHS procedures done in Nigeria.

Analysis of a five year experience of permanent pacemaker implantation at a Nigerian Teaching Hospital: need for a national database.

INTRODUCTION: Permanent pacemaker implantation is available in Nigeria. There is however no national registry or framework for pacemaker data collection. A pacemaker database has been developed in our institution and the results are analyzed in this study. METHODS: The study period was between January 2008 and December 2012. Patient data was extracted from a prospectively maintained database which was designed to include the fields of the European pacemaker patient identification code. RESULTS: Of the 51 pacemaker implants done, there were 29 males (56.9%) and 22 females (43.1%). Mean age was 68.2±12.7 years. Clinical indications were syncopal attacks in 25 patients (49%), dizzy spells in 15 patients (29.4%), bradycardia with no symptoms in 10 patients (17.7%) and dyspnoea in 2 patients (3.9%). The ECG diagnosis was complete heart block in 27 patients (53%), second degree heart block in 19 patients (37.2%) and sick sinus syndrome with bradycardia in 5 patients (9.8%). Pacemaker modes used were ventricular pacing in 29 patients (56.9%) and dual chamber pacing in 22 patients (43.1%). Files have been closed in 20 patients (39.2%) and 31 patients (60.8%) are still being followed up with median follow up of 26 months, median of 5 visits and 282 pacemaker checks done. Complications seen during follow up were 3 lead displacements (5.9%), 3 pacemaker infections (5.9%), 2 pacemaker pocket erosions (3.9%), and 1 pacemaker related death (2%). There were 5 non-pacemaker related deaths (9.8%). CONCLUSION: Pacemaker data has been maintained for 5 years. We urge other implanting institutions in Nigeria to maintain similar databases and work towards establishment of a national pacemaker registry.

An assessment of the competence and experience of dentists with the management of medical emergencies in a Nigerian teaching hospital.

BACKGROUND: Previous reports show that medical emergency events have ocurred in Teaching Hospital Dental centres, with attendant mortality and morbidity. OBJECTIVES: (1) To study the pattern of medical emergencies encountered by clinical dental staff of Lagos University Teaching Hospital (2) To evaluate their training, perception of their training and competence as undergraduates and postgraduates to manage such events. METHODS: All the clinical staff viz: Dental surgeons of different cadres--consultants, registrars, house surgeons and dental nurses of Lagos University Teaching Hospital. A structured questionnaire requesting to know demographic data, respondents attendance of life support training viz: Basic life support (BLS), advanced trauma life support (ATLS), intensive care support (ICS). A self rating in the competence of management of medical emergencies and previous personal encounter with medical emergencies with success/failure in the management with/or without medical colleage assistance were sought. In addition adequacy of their dental clinic/centres for drugs, equipments and their perceived readiness to deal with emergencies were enquired. RESULTS: Among the dental surgeons, 20 (26.6%) were consultants, 40 (53.3%) were registrars and 35 (46.6%) were house-officers. Thirty five (43.7%) had previous knowledge of basic life support (BLS) training, while 45 (56.2%) denied such knowledge. The figures for other trainings such as advanced trauma life Support (ATLS) was 8 (10%) and intensive care support (ICS) 2 (2.5% 73.3% of the respondents felt inadequate in the management of cardiovascular emergencies, while only 15.4% felt adequately prepared. Similar ratings for respiratory emergencies are 63.1% inadequacy, 16.9% adequacy, and only 3.3% felt very adequate. The availability of oxygen extension tubing and ambu bag was nil in all departments. Emergency drugs were claimed to be present by 28.5% oral surgery respondents and, 34.7% Child Dental Health respondents. Most of the respondents felt their clinics are not adequately prepared to deal with medical emergencies. CONCLUSION: The study showed that syncope is the commonest medical emergency event in dental surgery practice in our teaching hospital, others are bleeding, seizure disorders and asthmatic attacks. The constitution of hospital emergency team (consisting of cardiologists, anaesthetists) as done in advanced countries is advocated and dentists should ensure that the departmental staff are adequately trained to provide basic life support.

Misconceptions of hypertension.

A prospective questionnaire study of the misconceptions of hypertension by hypertensive patients was carried out in 1365 male and female hypertensive patients aged between 21-80 years. About 40% of the study population could not define hypertension, but even those who did appeared to be in denial of the disease. About 24% were unaware of the causes of hypertension; the most common cause mentioned was psychosocial stress. Between 0.6% and 14% of subjects were unaware of the effect of risk factors, like obesity, cigarette smoking, exercise, excessive alcohol and salt consumption, or hypertension. Interestingly, some feel that regular sexual intercourse worsens hypertension. Eight percent of subjects had no fear of the effect of poor compliance to antihypertensive medication, while 10% were anxious about the heavy financial burden imposed by hypertension management, Sixty-five percent of subjects feel that they will require no more medication once they achieve control of their blood pressure. Twenty-one percent of respondents are of the opinion that they will achieve a permanent cure only from alternative medical practitioners and will consider using alternative medicine in future. The study confirms the importance of medical education for patients irrespective of their level of education, as many of these patients still entertain that gross misconceptions may have negative impact on outcome.