Non-vaccine serotype pneumococcal carriage in healthy infants in South Africa following introduction of the 13-valent pneumococcal conjugate vaccine.

BACKGROUND: Pneumococcal carriage studies provide a baseline for measuring the impact of pneumococcal conjugate vaccines (PCVs). The advent of conjugate vaccines has led to reductions in vaccine serotypes (VTs) in pneumococcal carriage. However, increasing non-vaccine serotypes (NVTs) remain a significant concern, necessitating continued surveillance of serotypes in the 13-valent PCV vaccine (PCV13) era. OBJECTIVES: To investigate pneumococcal carriage, serotype distribution and risk factors for pneumococcal colonisation among children presenting for routine immunisation at two clinics in Gauteng Province, South Africa (SA), 10 years after PCV introduction into the SA Expanded Programme on Immunisation (EPI-SA). METHODS: Nasopharyngeal swabs were collected from 322 healthy children aged between 6 weeks and 5 years at two clinic centres in 2014 and 2016. Demographic data, risk factors for colonisation and vaccination details were recorded. The pneumococcal isolates were serotyped and tested for antimicrobial susceptibility. RESULTS: Pneumococci were isolated from 138/316 healthy children (43.7%) presenting for routine immunisation at two clinics. The median age was 8.3 months and the age range 1.4 months - 5 years. Carriage varied across the age groups: 6 - 14 weeks 35.5%, 9 months 27.5%, 18 months 21.7%, and 5 years 15.2%. Risk factors significantly associated with pneumococcal colonisation included young age (9 - 18 months (odds ratio OR 3.5; 95% confidence interval (CI) 1.9 - 5.9), type of dwelling (single room (OR 8.1; 95% CI 1.3 - 52.3) or informal dwelling (OR 2.4; 95% CI 1.2 - 4.5)) and Haemophilus influenzae carriage (OR 5.6; 95% CI 0.6 - 2.5). Of the 26 serotypes detected, 19F (10/121; 8.3%) was the most frequent. The most frequent NVTs were 23B (16/121; 13.2%), 15B/C (14/121; 11.6 %) and 35B (11/121; 8.2%). Children aged 9 months carried the highest proportion of NVTs (33/101; 32.7%). Penicillin non-susceptibility was observed in 20 NVT isolates (20/36; 55.6%) and 2 VT isolates (2/36; 5.6%). CONCLUSIONS: The pneumococcal carriage prevalence described in our study varied across the age groups and was lower compared with other African studies that looked at pneumococcal carriage post PCV. The study gave insight into the common NVTs encountered at two immunisation clinics in Gauteng. Given that pneumococcal carriage precedes disease, common colonisers such as 15B/C and 35B may be sufficiently prevalent in carriage for expansion to result in significant disease replacement.

Factors related to hospital readmissions in people with spinal cord injury in South Africa.

BACKGROUND: People with spinal cord injury (PWSCI) face various challenges after being discharged from rehabilitation that can result in readmission to hospital. Little is known about readmission of PWSCI in South Africa (SA). Readmission is costly, interrupts community involvement and negatively affects quality of life. OBJECTIVES: To investigate readmission rates within 5 years of rehabilitation, causes of readmission and factors related to readmission in PWSCI in Pretoria, SA. METHODS: We quantitatively analysed retrospective data gathered from files of patients admitted to a private rehabilitation facility in Pretoria between January 2008 and December 2012. Data were analysed using Stata 13 statistical software. Descriptive statistics were initially presented. Univariate logistic regression was used to identify individual factors that had significant association with the outcome measure (readmission). Thereafter, multivariate logistic regression was used to identify risk factors for readmission. The level of statistical significance was set at p<0.5. RESULTS: Data from 543 patient files were analysed. In total, 100 patients (18%) were readmitted between January 2008 and December 2012. Twenty-eight of the 100 readmitted patients had a subsequent second readmission, 10 patients had a third readmission, and 2 patients were readmitted for a fourth time. The most common reason for readmission was secondary health conditions (SHCs) (80%), followed by further rehabilitation, including gait rehabilitation (12%). Eight patients (8%) had undocumented reasons for readmission. The common SHCs in the first readmission were pressure ulcers (39%), followed by urinary tract infections (12%), deteriorating neurological status (6%) and constipation (3%). Patients with paraplegia had 2.3 times greater odds of readmission compared with tetraplegics (p=0.000, 95% CI 1.47 - 3.55). Those in the category T1 - T6 level of injury had 2.6 times greater odds of readmission (p=0.04, 95% CI 1.04 - 6.71, while those with incomplete spinal cord injury had 2.5 times greater odds (p=0.001, 95% CI 1.44 - 4.46). CONCLUSIONS: Factors related to patient injury profile such as type, completeness and level of injury were associated with a significant risk of readmission. SHCs were the main cause of readmission, and there is a need for effective programmes for their prevention.

Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors - A retrospective cohort study.

Aim This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient's socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. Methods Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients' mortality risk. Results A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2-81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6-131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7-23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. Conclusion Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

The impact of highly active antiretroviral therapy on the burden of bacterial lower respiratory tract infections in children.

BACKGROUND: Respiratory diseases are common and associated with significant morbidity and mortality in children. OBJECTIVE: To evaluate the prevalence and outcome of bacterial lower respiratory tract infections (LRTIs) in HIV-infected and uninfected children at a primary level hospital. METHODS: A cross-sectional descriptive study of children aged 6 months-18 years was conducted. Recruitment included HIV-positive children who had been on highly active antiretroviral therapy (HAART) for at least 6 months. A comparator group of HIV-negative children admitted with bacterial pneumonia was included. Laboratory data collected included CD4+ T-cell counts, HIV viral load and C-reactive protein (CRP). Data collected in both groups included demographic data, immunisation status, zinc supplementation, previous LRTIs, environmental exposures and treatment. RESULTS: Fifty-nine HIV-infected and 20 uninfected children were enrolled. The HIV-positive children were older, with a mean age of 107.2 (standard deviation 50.0) months v. 12.0 (5.8) months (p<0.005). The HIV-infected group had a mean CD4 percentage of 31.5%, and had had an average of 3.9 visits for bacterial LRTIs. All were treated with amoxicillin with no complications. In the HIV-uninfected group, cough and rapid breathing were the most common presenting symptoms, and the mean CRP level was 463.0 mg/L. The mean hospital stay was 4 days. CONCLUSION: HAART is effective in reducing the burden of LRTIs in HIV-positive children, even when the diagnosis is delayed. Cough and fast breathing are still the most reliable presenting symptoms of pneumonia. The majority of children still respond to amoxicillin as first-line therapy, with low complication rates.

Reasons for the low bacteriological coverage of tuberculosis reported in Mpumalanga Province, South Africa.

SETTING: Public sector hospitals and primary health clinics in the Mpumalanga Province of South Africa. OBJECTIVE: To determine whether failure to adhere to tuberculosis (TB) diagnostic guidelines (i.e., submit sputum for smear microscopy) contributed to the low bacteriological coverage reported for TB in 2008 in Mpumalanga Province. METHODS: We reviewed clinical records for new pulmonary TB cases at 30 of 118 randomly selected facilities that met the bacteriological coverage target of 80% and 30/87 facilities that did not. Data for hospital and clinic cases were abstracted into case report forms, captured electronically and compared with data from the electronic TB register (ETR). We assessed age, sex, human immunodeficiency virus (HIV) infection and facility type as potential confounders for recording of smear microscopy results. RESULTS: Age, sex and HIV infection did not influence recording of results. In hospitals, 61.8% of pulmonary TB cases had sputum smear results in their clinical records compared to 93.6% at clinics (P < 0.001). Of the 711 cases (30.3%) that did not have smear results in the ETR, 342 (48.1%) did have smear results in their clinical records. CONCLUSION: Both poor clinical practice (especially in hospitals) and poor record keeping have contributed to the low bacteriological coverage reported. These shortcomings need to be addressed to improve patient care and programme management.

Contexte : Hôpitaux publics et centres de santé primaire de la province de Mpumalanga en Afrique du Sud.Objectif : Déterminer si le défaut de respecter les directives de diagnostic de la tuberculose (TB) (c'est-à-dire soumettre des crachats à la microscopie de frottis) a contribué à la faible couverture bactériologique rapportée en 2008.Méthodes : Nous avons revu les dossiers cliniques des nouveaux cas de TB pulmonaire dans 30 de 118 structures sélectionnées au hasard qui ont atteint la couverture bacteriologique visée de 80% et 30 de 87 structures qui ne l'ont pas atteinte. Les données des cas suivis dans les hôpitaux et les dispensaires ont été résumées sur des formulaires, saisies en informatique et comparées aux données du registre électronique de la TB (ETR). Nous avons évalué l'âge, le sexe, l'infection au virus de l'immunodéficience humaine (VIH) et le type de structure en tant que facteurs de confusion de l'enregistrement des frottis.Résultats : L'âge, le sexe et l'infection VIH n'ont pas influencé l'enregistrement des frottis. Dans les hôpitaux, 61,8% des cas de TB pulmonaire ont eu des résultats de frottis de crachats dans leurs dossiers cliniques comparés à 93,6% dans les dispensaires (P < 0,001). Sur les 711 cas (30,3%) qui n'avaient pas de résultats de frottis dans le ETR, 342 (48,1%) avaient des résultats de frottis dans leurs dossiers cliniques.Conclusion : La faible couverture bactériologique constatée est due à la fois à des pratiques cliniques médiocres (surtout dans les hôpitaux) et à une maintenance insuffisante des dossiers. Ces deux problèmes doivent être résolus afin d'améliorer la prise en charge des patients et la gestion du programme.

Marco de referencia: Los hospitales y los centros de atención primaria del sector público de salud de la provincia de Mpumalanga en Suráfrica.Objetivo: Determinar si la falta de cumplimiento de las normas diagnósticas de la tuberculosis (TB) (por ejemplo, la presentación de muestras de esputo para baciloscopia) contribuye a la baja cobertura bacteriológica notificada en el 2008.Métodos: Se analizaron las historias clínicas de los casos nuevos de TB pulmonar en 30 de los 118 establecimientos escogidos de manera aleatoria que cumplían con la meta de cobertura bacteriológica del 80% de los casos y en 30 de los 87 centros que no cumplían con esta meta. Los datos de los casos de los hospitales y los consultorios se consignaron en formularios de notificación, se captaron en un registro informático y se compararon con los datos del registro electrónico de la TB (ETR). Se evaluaron la edad, el sexo, la infección por el virus de la inmunodeficiencia humana (VIH) y el tipo de establecimiento como posible factores de confusión del registro de la baciloscopia.Resultados: La edad, el sexo y la infección por el VIH no ejercieron ninguna influencia sobre el registro de la baciloscopia. En los hospitales, el 61,8% de los casos de TB pulmonar contaba con resultados de la baciloscopia del esputo en la historia clínica, en comparación con el 93,6% de los casos en los consultorios (P < 0,001). De los 711 casos que carecían de resultados de baciloscopia en el ETR (30,3%), 342 contaban con esta información en los expedientes clínicos (48,1%).Conclusión: Se observaron prácticas clínicas inadecuadas (sobre todo en los hospitales) y deficiencias en los registros, que contribuyeron a la baja cobertura bacteriológica notificada. Es importante remediar estas insuficiencias con el fin de mejorar la atención que se presta a los pacientes y optimizar la gestión del programa contra la TB.

Comparison of equations for the calculation of LDL-cholesterol in hospitalized patients.

BACKGROUND: The Friedewald equation is widely used to calculate LDL-C for cardiovascular risk prediction but is less accurate with comorbidities and extreme lipid values. Several novel formulae have been reported to outperform the Friedewald formula. METHODS: We examined 14,219 lipid profiles and evaluated four formulae (Friedewald, Chen, de Cordova, Hattori) and compared these to direct measurement of LDL-C across various triglyceride (TG), total cholesterol (TC) and HDL-cholesterol (HDL-C) ranges using Beckman reagents and instruments. Linear regression and ROC analysis were performed. RESULTS: The de Cordova formula showed a high correlation with directly measured LDL-C (r=0.90, P<0.001), comparable to the Friedewald calculated values for directly measured LDL-C (r=0.95, P<0.001). The de Cordova formula was favorable in some ranges of HDL, TC and the lowest TG range (r=0.97, P<0.001) but performed least well in comparison with the three other LDL-C calculations (AUC=0.8331), demonstrating inconsistent bias. The Chen formula performed better than Friedewald (AUC=0.9049). The Hattori formula outperformed all formulae including Friedewald over various ranges of lipid values (AUC=0.9097). CONCLUSIONS: We observe favorable correlations of the de Cordova formula with Friedewald at low TG values. However, the Hattori formula appears to be best for application in hospitalized patients, even at extreme lipid values.

The effect of a workplace intervention programme on return to work after stroke: a randomised controlled trial.

OBJECTIVE: To determine the effect of a workplace intervention programme on the rate of return to work of previously employed stroke survivors in the Gauteng province of South Africa. DESIGN: A randomised controlled trial. SETTING: Participants' workplaces and three hospitals with stroke rehabilitation facilities. SUBJECTS: Eighty stroke survivors between the ages of 18 and 60 years who were employed at the time of stroke onset. INTERVENTION: The workplace intervention programme was tailored according to functional ability and workplace challenges of each stroke survivor. The control group received usual stroke care which took into consideration job requirements but without workplace intervention. MAIN OUTCOMES: The primary outcome was return to work rate. Secondary outcomes included activities of daily living (ADLs), mobility, basic cognitive function and perceived quality of life. RESULTS: At six months follow-up 60% (n = 24) of stroke survivors in the intervention group returned to work compared to 20% (n = 8) in the control group (P <0.001). The odds ratio for return to work for stroke survivors in the intervention group was 5.2. For every unit increase in the ADLs and cognitive assessment score, the odds of return to work increased by 1.7 and 1.3 respectively; those who returned to work had better quality of life than those who did not return to work (P = 0.05). CONCLUSION: A workplace intervention consisting of workability assessments and workplace visits was effective in facilitating return to work for stroke survivors in the Gauteng province of South Africa.

Static and dynamic balance ability, lumbo-pelvic movement control and injury incidence in cricket pace bowlers.

OBJECTIVES: This study aimed to establish the difference in lumbo-pelvic movement control, static and dynamic balance at the start and at the end of a cricket season in pace bowlers who sustained an injury during the season and those who did not. DESIGN: This is a longitudinal, observational study. METHODS: Thirty-two, healthy, injury free, male premier league fast, fast-medium and medium pace bowlers between the ages of 18 and 26 years (mean age 21.8 years, standard deviation 1.8 years) participated in the study. The main outcome measures were injury incidence, lumbo-pelvic movement control, static and dynamic balance ability. RESULTS: Fifty-three percent of the bowlers (n=17) sustained injuries during the reviewed cricket season. Lumbo-pelvic movement control tests could not discriminate between bowlers who sustained an injury during the cricket season and bowlers who did not. However, performance in the single leg balance test (p=0.03; confidence interval 4.74-29.24) and the star excursion balance test (p=0.02; confidence interval 1.28-11.93) as measured at the start of the season was better in bowlers who did not sustain an injury during the season. CONCLUSIONS: The improvement in the lumbo-pelvic movement control and balance tests suggests that the intensity and type of physical conditioning that happens throughout the season may have been responsible for this improvement. Poor performance in the single leg balance test and the star excursion balance test at the start of the cricket season may be an indication that a bowler is at heightened risk of injury.

Efficacy of a pectin-lecithin complex for treatment and prevention of gastric ulcers in horses.

The objective of this study was to evaluate the effect of a commercial feed supplement containing pectin-lecithin on squamous mucosa ulceration in horses exposed to an experimental ulceration model. Five mares were treated while five mares were controls for this crossover, blinded study. The mares were fed concentrates and hay and were stabled with a two-hour turn out per day for a period of four weeks. The pectin-lecithin complex was fed for the duration of the study on the treated group. At the end of a four-week period, all mares underwent a seven-day alternating feed deprivation (week 5). The study was repeated again after a four-week washout period. Gastroscopy was performed on days 1, 28 and 35 of the study and was digitally recorded. Independent evaluation of the recordings and scoring of the lesions using the Equine Gastric Ulcer Syndrome (EGUS), severity and number scores were performed by three experienced gastroscopists. The prevalence and severity of squamous ulcers significantly increased after intermittent feed deprivation (P<0.001). No significant effect of the treatment was observed (P>0.05). In this study, the addition of a commercially available pectin-lecithin complex to the feed of horses for five weeks did not prevent or minimise the risk for gastric ulceration of the squamous mucosa.

Post traumatic stress disorder and resilience in veterans who served in the South African border war.

OBJECTIVE: The psychological impact of the South African border war on veterans has received little or no attention. This study determined the prevalence of post-traumatic stress disorder (PTSD), and extent of resilience among a cohort of veterans. METHOD: Of 1527 former students who matriculated from a Johannesburg high school from 1975 to 1988, only 109 were reachable for convenience and snowballing recruitment into this study. An anonymous, internet-based questionnaire was used to obtain information on demography, combat exposure, drug and alcohol use, traumatic events in later life, and recourse to medication and counselling. The Impact of Event Scale - Revised (IES-R) assessed for PTSD and the Connor Davidson Resilience Scale (CDRISC) measured resilience. Data were processed with STATA; version 11 statistical software package. Analysis included Chi square test and regression analysis. RESULTS: The response rate was 49.5% (n=54). The prevalence of PTSD was 33% and significantly associated with combat exposure (p=.012). Despite high prevalence of PTSD in those exposed to combat, 94% showed normal to above-normal level of resilience. CD-RISC scores showed no association with the IES-R. Only current cannabis use was significantly linked with PTSD (p=.044). CONCLUSION: Although the prevalence of PTSD found in this sample was higher than in comparable international studies, this cohort of former SA national servicemen, showed high levels of resilience. The current use of cannabis within the context of prior exposure to military national service or combat should prompt clinicians to screen for the presence of PTSD-associated symptoms.

Phenotypic expression of the 3120+1G>A mutation in non-Caucasian children with cystic fibrosis in South Africa.

INTRODUCTION: Cystic fibrosis (CF) is the most common genetic disorder in Caucasians. Presentation of CF in non-Caucasians is less well studied. OBJECTIVE: This audit was undertaken to determine the phenotypic expression of the 3120+1G>A mutation in black and mixed race children in South Africa. METHODS: A multi-centre retrospective chart review of clinical, laboratory and spirometry data of non-Caucasian CF patients in four CF centres in South Africa was collected. Data was collected at diagnosis and after a five-year follow-up period. Ethical approval was granted for the study. RESULTS: A total of 30 participants were enrolled of whom 14 (47%) were homozygous and 16 (53%) heterozygous for the 3120+1G>A mutation. The mean age of diagnosis was 13 months. Twenty-four (80%) patients had malnutrition (mean weight z-score -3.6) or failure to thrive (77%) at presentation. Twenty (67%) presented with non-specific abdominal symptoms, whilst fifteen (50%) had recurrent respiratory tract infections. Pseudomonas aeruginosa was detected at a mean age of 21 months. The mean FEV1 was 73% predicted (95% CI 54.0-91.1) at study entry and 68% predicted (95% CI 49.74-87.06) at follow-up. CONCLUSION: Failure to thrive and a diagnosis of protein energy malnutrition (kwashiorkor) are the common presenting features of CF in children with the 3120+1G>A mutation. Meconium ileus is a rare presenting feature of CF in black and mixed race children with this deletion in South Africa.

Comparison of HTLV-associated myelopathy (HAM) in HIV-positive and HIV-negative patients at a tertiary South African hospital.

BACKGROUND: HTLV-1 associated myelopathy (HAM), or tropical spastic paraparesis, is caused by a retrovirus, the human T-cell lymphotropic virus (HTLV). Although patients with HAM and HIV infection have been described, to our knowledge no direct comparison has been made between patients who are HIV positive and suffering from HAM (HHAM) v. those who are HIV negative and suffering from HAM. AIM: We aimed to compare clinical and radiological findings in HIV-positive and -negative patients with HAM. METHODS: Adult patients who presented to the Neurology Unit at the Steve Biko Academic Hospital from May 2005 to June 2012 with a progressive myelopathy and HTLV seropositivity were retrospectively identified and their clinical and radiological data were collected and reviewed. RESULTS: 21 patients with HAM were identified, of whom 9 were HIV-positive and 11 HIV-negative. One patient, whose HIV status had not been established, was not included in the study. Although the trend did not reach statistical significance, co-infected patients tended to present at an earlier age (HHAM 6/9 (66%) <40 years old; HAM 2/11 (18%) <40 years old) and presented to hospital earlier (HHAM 6/9 (66%) < 3 years symptomatic; HAM 7/11 (63%) > 3 years symptomatic). Cord atrophy occurred in 7/8 dually infected patients and 8/10 HIV-negative patients. CONCLUSION: Although the study is limited by the small number of patients, co-infected patients tended to have a younger age of onset and to present to hospital sooner, and thoracic cord atrophy was very common.

Diagnosis and treatment of schizophrenia in a general hospital based acute psychiatric ward.

OBJECTIVES: To review and describe the clinical profile and acute in-patient treatment of patients diagnosed with schizophrenia over a four-year period; to review and describe the documented evidence for the diagnosis of schizophrenia; and to identify possible associated or predictive factors in the acute in-patient treatment outcome of patients at an acute (designated for 72-hour assessments) ward - within a general hospital, Helen Joseph Hospital (HJH). METHOD: Routine discharge summaries were used in a retrospective clinical review of patients with schizophrenia. The demographic, clinical and treatment profile of these patients were described and the documented evidence for the diagnosis of schizophrenia was reviewed using descriptive and comparative statistics. Factors were evaluated to assess their association with the length of stay (LOS) as outcome variable, using "Generalized Linear Latent and Mixed Models" (GLLAMM). RESULTS: A total of 436 patients were diagnosed with schizophrenia, constituting on average about 20% of the total numbers of admissions. The overall mean LOS was 19.5 days. Considering DSM IV-TR criteria for schizophrenia, behavior problems were confirmed in 71.8% (n=313), perceptual disturbances in 29% (n=126) and thought disorders in 83.5% (n=364). The duration of symptoms were specified in 68% (n=298) patients. Age (p<0.001), gender (p<0.019), substance abuse (p<0.019) and follow-up referral (p<0.000) were significantly associated with LOS. CONCLUSION: The study contributed by identifying these predictive indicators for the acute in-patient treatment outcome of patients with schizophrenia. Future standard operational procedures for diagnostic and treatment processes in acute wards may have to include structured interviews in order to enhance the quality of the routine process of diagnosis and treatment of patients with schizophrenia.

Diagnosis and treatment of schizophrenia in a general hospital based acute psychiatric ward

Abstract Objectives: To review and describe the clinical profile and acute in-patient treatment of patients diagnosed with schizophrenia over a four-year period; to review and describe the documented evidence for the diagnosis of schizophrenia; and to identify possible associated or predictive factors in the acute in-patient treatment outcome of patients at an acute (designated for 72-hour assessments) ward ­ within a general hospital, Helen Joseph Hospital (HJH). Method: Routine discharge summaries were used in a retrospective clinical review of patients with schizophrenia. The demographic, clinical and treatment profile of these patients were described and the documented evidence for the diagnosis of schizophrenia was reviewed using descriptive and comparative statistics. Factors were evaluated to assess their association with the length of stay (LOS) as outcome variable, using "Generalized Linear Latent and Mixed Models" (GLLAMM). Results: A total of 436 patients were diagnosed with schizophrenia, constituting on average about 20% of the total numbers of admissions. The overall mean LOS was 19.5 days. Considering DSM IV-TR criteria for schizophrenia, behavior problems were confirmed in 71.8% (n=313), perceptual disturbances in 29% (n=126) and thought disorders in 83.5% (n=364). The duration of symptoms were specified in 68% (n=298) patients. Age (p<0.001), gender (p<0.019), substance abuse (p<0.019) and follow-up referral (p<0.000) were significantly associated with LOS. Conclusion: The study contributed by identifying these predictive indicators for the acute in-patient treatment outcome of patients with schizophrenia. Future standard operational procedures for diagnostic and treatment processes in acute wards may have to include structured interviews in order to enhance the quality of the routine process of diagnosis and treatment of patients with schizophrenia

Fertility of N'dama and Bunaji cattle to artificial insemination following oestrus synchronization with PRID and PGF2alpha in the hot humid zone of Nigeria.

A study was undertaken to determine the effectiveness of a progesterone-releasing intravaginal device (PRID) and prostaglandin F2 alpha (PGF2alpha) in synchronizing oestrus in N'dama and Bunaji cows and heifers and the fertility following artificial insemination at the synchronized oestrus. A total of 116 cows and heifers (58 N'dama and 58 Bunaji) were used in two separate trials. In the first trial, oestrus was synchronized using a PRID, which was inserted for 12 days; in the second trial, oestrus was synchronized by giving two injections of PGF2alpha 13 days apart. Only animals that did not respond to the first injection were given the second injection. At the end of each treatment period, the animals were observed for oestrus for 7 days and inseminated approximately 12 h following detection of oestrus. Standing to be mounted was the single criterion used to judge an animal to have been in oestrus. PGF2alpha and PRID were both effective in synchronizing oestrus in N'dama and Bunaji cows and heifers. The respective oestrus response rates, pregnancy rate and conception rates for PRID and PGF2alpha were 85.7%, 53.6% and 62.5% for PRID, and 91.7%, 68.3% and 74.6% for PGF2alpha. N'dama cattle showed significantly (p<0.05) better oestrus response rate, pregnancy rate and conception rate than Bunaji cattle following both PRID and PGF2alpha treatments. The pregnancy rate and conception rate following PGF2alpha treatment were better (p < 0.05) than for PRID, although the oestrus response rate did not differ. It is concluded that both PRID and PGF2alpha are effective in synchronizing oestrus in N'dama and Bunaji cattle in the hot humid zone of Nigeria and the fertility to artificial insemination at the synchronized oestrus was normal and acceptable. Thus, PRID and PGF2alpha can effectively be used in intensive breeding programmes for the rapid multiplication and distribution of both cattle breeds, especially the N'dama, which is a unique and beneficial animal genetic resource for the tsetse infested hot humid zone of Nigeria.