Challenges with Managing Delayed Presentation of Persistent Truncus Arteriosus with Torrential Pulmonary Blood Flow in a Resource-Limited Setting.

Embryologically, incomplete conotruncal septation with resultant single aortopulmonary trunk and defective ventricular septation defines the congenital cardiac lesion known as persistent truncus arteriosus (PTA). Torrential pulmonary blood flow is inevitable when this rare lesion is further compounded by patency of the arterial ductus. Such was the case of a patient who presented with fast breathing, reduced suck, darkening of the tongue, and extremities. Urgent echocardiographic diagnosis was PTA (Type A1) with patent ductus arteriosus and pulmonary hypertension and left ventricular systolic dysfunction.

Assessment of Sleep Quality among Medical Doctors in a Tertiary Hospital in a Semi-Rural Setting.

INTRODUCTION: Sleep is an integral part of human physiology; therefore, disorders of sleep may result in significant derangement in human functionality. Sleep medicine has received little attention in Nigeria. Against this backdrop, this survey seeks to evaluate the quality of sleep among doctors. METHODOLOGY: This was a cross-sectional descriptive study involving 59 doctors working with Federal Medical Centre Birnin Kebbi, Kebbi State, Nigeria; it was done between August 2017 and December 2017. Purposive sampling method was adopted. The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were adopted. The questionnaire was self-administered. RESULTS: There were 34 (57.6%) males and 25 (42.4%) females. Their age ranged from 20 to 66 years, with a mean of 34.39 ± 8.00. The Epworth score ranged from 8 to 29, with a mean of 16.1 ± 4.4, while the PSQI score ranged from 5 to 19, with a mean of 9.5 ± 2.7. The mean work hour per week was 90.3 ± 36.2 h, and majority of the respondents worked for >80 h and or >24 h consecutively in the preceding week, and most had high ESS scores; however, this observation was not statistically significant (Fisher's exact test = 4.0904, P = 0.213). All respondents were poor sleepers and majority sleep for <7 h in the night. Respondents had worked for 5 years and less; house officers and medical offers had more tendencies for daytime sleepiness. CONCLUSION: All respondents were poor sleepers and also had prolonged work hours per week; there was also heightened daytime sleepiness.

Sleep quality among nurses in a tertiary hospital in North-West Nigeria.

BACKGROUND: Sleep is a necessity; it is nourishing, refreshing and healing. The nursing profession is associated with busy and difficult work schedules, especially the running of shifts which has been associated with cardiovascular and metabolic complications. There is a dearth of local data on sleep disorders, especially among nurses. In this study, we evaluated the quality of sleep and the tendency of daytime sleepiness among nurses. SUBJECTS AND METHODS: This study was cross-sectional in nature involving 100 nurses working with Federal Medical Centre Birnin Kebbi, Kebbi State; the study was carried out between October 2016 and February 2017. The Pittsburg Sleep Quality Index was used to determine poor sleepers; while the Epworth Sleepiness Scale (ESS) was adopted to determine the presence of tendency of daytime sleepiness; 0-7 was considered normal, 8-9 represented average tendency of daytime sleepiness, 10-15 represented excessive daytime sleepiness, while 16-24 represented daytime sleepiness requiring medical intervention. P < 0.05 was set as statistically significant. RESULTS: There were 23 (23%) males and 77 (77%) females, with a male-to-female ratio of 0.3:1. The age range was 18-50 years, with a mean age of 31.4 ± 8.6 years. The ESS score ranged from 0.0-17.0, with a mean score of 7.3 ± 3.5; while the Pittsburg score ranged between 1 and 15, with a mean score of 5.7 ± 2.7, and 61% of the nurses had a poor sleep quality. There was unlikely tendency of excessive sleepiness across all the age groups, though this was not statistically significant (χ2 = 7.258, P = 0.283), and poor sleep quality was most prevalent among the 25-40-year-old group but this observation was also not statistically significant (χ2 = 2.259, df = 2, P = 0.334). CONCLUSION: Poor sleep quality is a problem among nurses, though less tendency to daytime sleepiness was observed in this report.

Sleep Pattern and Sleep Hygiene Practices among Nigerian Schooling Adolescents.

BACKGROUND: Sleep problems, especially in the adolescent stage of development, may be associated with excessive daytime sleepiness, impaired neurocognitive function, and a host of others leading to suboptimal performance. OBJECTIVES: To determine the pattern of sleep problems in school-going adolescents based on the bedtime problems; excessive daytime sleepiness; awakenings during the night and problems falling back asleep; regularity and duration of sleep; sleep-disordered breathing (BEARS) sleep screening algorithm. MATERIALS AND METHODS: This is a cross-sectional descriptive study involving 353 secondary school-going adolescents in Kano metropolis. Subjects were selected for the study using multistage sampling technique. The study lasted from March 2015 to July 2015. Sleep problems were screened for using the BEARS sleep screening algorithm. Tables were used to present the qualitative data. The various BEARS sleep patterns were assessed, and comparison between stages of adolescence was done using Chi-square test (and Fisher's exact test where necessary). A significant association was considered at P < 0.05. RESULTS: Of the 353 adolescents studied, 61.8% were males while 38.2% were females with male, female ratio of 1.6:1. Early, middle, and late adolescents constituted 13.9%, 39.9%, 46.2% respectively. BEARS sleep screening revealed awakenings during the night (34.6%) as the most common sleep-related problem reported, and this was followed by excessive daytime sleepiness (21.0%). Age-group dependent sleep duration was 7.19 ± 1.26, 7.13 ± 1.13, 7.16 ± 1.28, with P > 0.05. Although 62.9% of all the adolescents watched TV/play video games until 1 h before going to bed and this was highest in late adolescence, it was not statistically significantly associated with any of the sleep problems. CONCLUSION: Both the quality and quantity of sleep in Nigerian adolescents in Kano is suboptimal. Adolescent and sleep medicine should receive more attention in our environment.

Pyopericardium with Cardiac Tamponade in a Nigerian Child with Acute Osteomyelitis.

In pyopericardium, pus accumulates in the pericardial space as a result of infection by pyogenic organisms, most common of which are Staphylococcus aureus and Mycobacterium tuberculosis. These patients are at risk of cardiac tamponade. Apart from pericardiocentesis in the management of these patients, definitive drug treatment may pose a formidable challenge in a setting of coinfection as in patients with tuberculosis who are predisposed to secondary bacterial infections. This was the case of our patient. We here highlight the challenges faced with etiologic diagnosis in resource-limited settings.