Clinical Utility of Procalcitonin and C-Reactive Protein in the Management of Neonatal Sepsis in a Resource-Limited Nigerian Hospital.

BACKGROUND: Neonatal sepsis is an invasive infection of the bloodstream in neonates and a leading cause of morbidity and mortality among them. AIM: To investigate the role of procalcitonin (PCT) and C-reactive protein (CRP) in the management of neonatal sepsis. MATERIALS AND METHODS: This was a prospective case-control study over one-year period using convenience sampling. Blood samples for PCT and CRP were taken from all neonates, while blood culture and white blood cell count samples were additionally taken from babies with neonatal sepsis. PCT and CRP were repeated at 24 and 48 hours. The continuous variables were found to have a nonparametric distribution. They were presented as median and interquartile range, and compared using Wilcoxon signed rank and Friedman test as appropriate. RESULTS: The blood culture analysis yielded a prevalence of 12.7% with Staphylococcus aureus being the commonest organism. Baseline concentrations of PCT (1.28 ng/ml) and CRP (17.31 mg/L) in neonates with sepsis were higher than that of controls (PCT-0.63 ng/ml, CRP-5.40 mg/L). PCT concentrations decreased after two days of antibiotic treatment, while CRP concentrations decreased after a day. The concentration of both decreased to normal levels after two days of treatment. CONCLUSION: This study showed that CRP was more reliable in monitoring antibiotic therapy, unlike other studies which suggested PCT. In cases where the management of neonatal sepsis may be limited by a low blood culture yield, therapeutic monitoring may be aided by CRP and/or PCT.

Barriers and Facilitators of Isoniazid Preventive Therapy Implementation among People Living with HIV in Nigeria: A Scoping Review of the Literature.

BACKGROUND: Implementation of Isoniazid Preventive Therapy (IPT) among People Living with HIV (PLHIV) continues to be a significant challenge, and there is a shortage of effective interventions. This scoping review aimed to determine barriers and facilitators of IPT implementation including its uptake and completion among PLHIV in Nigeria. METHODS: PubMed, Medline Ovid, Scopus, Google scholar, web of science and Cochrane Library were searched for articles published between January 2019 to June 2022 that addressed barriers and facilitators of IPT uptake and completion in Nigeria. The study used the PRISMA checklist to ensure the quality of the study. RESULTS: The initial search revealed 780 studies, of which 15 studies were finally included in the scoping review. The authors inductively organized IPT barriers among PLHIV into patients-, health system-,programmatic- and provider-related barriers. Facilitators of IPT were sub-categorized into programmatic (Monitoring and Evaluation or logistic), patient-related and provider-related (capacity building) and health systems sub-categories. Most studies highlighted more barriers than facilitators, and across all studies, IPT uptake was 3% - 61.2% while IPT completion was 40 - 87.9% but these figures are higher in quality improvement studies. CONCLUSION: Identified barriers include health system, and programmatic-across, and in all the studies, IPT uptake was 3%-61.2%. Cost-effective and locally developed interventions addressing context-specific barriers should be developed to address patient, provider, programmatic, and health systems-specific findings in our study with a clear understanding that there may be other barriers limiting uptake and completion of IPT at the level of community and caregivers.

CONTEXTE: CONTEXTE: La mise en œuvre du traitement préventif à l'isoniazide (TPI) chez les personnes vivant avec le VIH (PVVIH) reste un défi de taille, et il y a une pénurie d'interventions efficaces. Cette étude exploratoire visait à déterminer les obstacles et les facilitateurs de la mise en œuvre du TPI, y compris son adoption et son achèvement parmi les personnes vivant avec le VIH au Nigéria. MÉTHODES: PubMed, Medline Ovid, Scopus, Google scholar, web of science et Cochrane Library ont été recherchés pour les articles publiés entre janvier 2019 et juin 2022 qui traitaient des obstacles et des facilitateurs de l'adoption et de l'achèvement du TPI au Nigéria. L'étude a utilisé la liste de contrôle PRISMA pour garantir la qualité de l'étude. RÉSULTATS: La recherche initiale a révélé 780 études, dont 15 ont finalement été incluses dans l'examen de la portée. Les auteurs ont organisé de manière inductive les obstacles au TPI chez les PVVIH en barrières liées aux patients, aux systèmes de santé, aux programmes et aux prestataires. Les facilitateurs du TPI ont été subdivisés en souscatégories liées aux programmes (suivi et évaluation ou logistique), aux patients et aux prestataires (renforcement des capacités) et aux systèmes de santé. La plupart des études ont mis en évidence plus d'obstacles que de facilitateurs et, dans l'ensemble des études, le taux d'utilisation du TPI était compris entre 3 % et 61,2 %, tandis que le taux d'achèvement du TPI était compris entre 40 % et 87,9 %, mais ces chiffres sont plus élevés dans les études d'amélioration de la qualité. CONCLUSION: Les obstacles identifiés sont liés au système de santé et aux programmes, et dans toutes les études, le taux d'utilisation du TPI était compris entre 3 % et 61,2 %. Des interventions rentables et développées localement pour faire face aux obstacles spécifiques au contexte devraient être mises au point pour répondre aux conclusions de notre étude concernant les patients, les prestataires, les programmes et les systèmes de santé, tout en sachant qu'il peut y avoir d'autres obstacles qui limitent l'adoption et l'achèvement de l'IPT au niveau de la communauté et des soignants. Mots-clés: Thérapie préventive à l'isoniazide; Personnes vivant avec le VIH; Obstacles; Facilitateurs; Adoption; Achèvement.

How can we help? Medical students' views on their role in the COVID-19 pandemic.

BACKGROUND: The ongoing COVID-19 pandemic has resulted in a sharp rise in demand for healthcare workers worldwide. This has been coupled with reduced numbers of available medical professionals due to confirmed or suspected infections with SARS-CoV-2. To counteract these shortages, governments of several countries have considered the enrolment of medical students into the workforce in order to help to tackle the ongoing crisis. METHODS: Questionnaire-based study assessing the perceived role of medical students in assisting in the COVID-19 pandemic. The primary aim was to determine factors contributing to the willingness of medical students to actively assist in the pandemic. The secondary aim was to evaluate their perspectives regarding the associated changes in medical education. RESULTS: Out of 760 responses, 71.18% of medical students were willing to assist the medical workforce during the pandemic. Clinical year students were more likely to help in a medical capacity than pre-clinical students (OR = 0.384, 95%CI [0.167, 0.883, P < 0.05)]. Respondents concerned about their own well-being were less likely to engage in clinical work (OR = 0.680, 95%CI [0.491, 0.941], P < 0.020). Students who agreed that online lectures will negatively impact their education were inclined to think that the academic year should be extended (95%CI [0.065, 0.271], P = 0.001). CONCLUSIONS: Most students are willing to help in both a medical and non-medical capacity. Their primary concerns when working in a medical setting are the risk of infecting their relatives and patients, lack of protective equipment and necessary knowledge as well as legal uncertainty whilst working without a medical qualification.

Biochemical Assessment of Cardiovascular Risk Associated with the Duration of Antipsychotic Therapy in Patients with Schizophrenia.

BACKGROUND AND OBJECTIVES: Schizophrenia accounts for 78% of cases managed in Behavioural Sciences in Nigeria, and treatments with antipsychotic drugs may contribute to the onset of coronary heart disease (CHD) due to dyslipidaemia - associated complications. The prevention of CHD is preferable and less expensive than its management; thus, early identification and treatment may offer the possibility of reducing the devastating sequel. The aim of this study was to investigate the pattern of dyslipidaemia and cardiovascular risk (CVR) associated with duration of antipsychotic therapy inorder to improve awareness on early diagnosis, treatment and CVR reduction. METHODS: This was a longitudinal (prospective) study involving 44 participants recruited through systematic random sampling. Each participant served as their own control. Four blood samples were obtained from each participant, starting with a baseline before the onset of antipsychotic therapy and subsequently at monthly intervals for three consecutive months from commencement of therapy. Parameters of routine and advanced lipid profiles were assayed and the atherogenic indices were calculated. RESULTS: Both the routine and advanced lipid profiles werewithin reference limits at baseline. A significant increase in monthly levels was observed with dyslipidaemia noticed by the second month of antipsychotic therapy. There was an association established between the duration of therapy and a high CVR. The TC/HDL-C ratio performed better than apo B-100 and individual routine lipid profile fractions in the evaluation of CVR. CONCLUSIONS: Dyslipidaemia associated with high CVR may develop with antipsychotic therapy. Calculation of atherogenic indices was a good indicator of CVR.

CONTEXTE ET OBJECTIFS: La schizophrénie représente pour 78 % des cas pris en charge en sciences du comportement au Nigeria, et les traitements par antipsychotiques peuvent contribuer à l'apparition de l'apparition de maladies coronariennes dues à la dyslipidémie et à ses complications. complications associées. La prévention des maladies coronariennes est préférable et moins coûteuse que leur gestion alors l'identification et le traitement précoces peuvent offrir la possibilité de réduire les séquelles dévastatrices. L'objectif de cette étude était d'examiner les caractéristiques de la dyslipidémie et du risque cardiovasculaire (CVR) associés à la durée du traitement antipsychotique afin d'améliorer la sensibilisation au antipsychotique afin de sensibiliser au diagnostic précoce, au traitement et à la à un stade précoce. MÉTHODES: Il s'agissait d'une étude longitudinale (prospective) impliquant 44 participants recrutés par échantillonnage aléatoire systématique. Chaque participant a servi comme une charge Quatre échantillons de sang ont été prélevés chez chaque participant, en commençant par une ligne de base avant le début du traitement. de référence avant le début du traitement antipsychotique, puis à intervalles puis à intervalles mensuels pendant trois mois consécutifs à partir du début du traitement. Les paramètres des profils lipidiques de routine et et avancés ont été analysés et les indices athérogènes ont été calculés. ont été calculés. RÉSULTATS: Les profils lipidiques de routine et avancés étaient tous deux dans les limites de référence au début du traitement. Une augmentation significative des Une augmentation significative des niveaux mensuels a été observée avec une dyslipidémie remarquée audeuxième mois de traitement antipsychotique. Une association a été établie établie entre la durée du traitement et un CVR élevé. Le rapport TC/HDL-C s'est révélé plus performant que l'apo B-100 et les les fractions individuelles du profil lipidique de routine dans l'évaluation de la CVR. CONCLUSIONS: Une dyslipidémie associée à une CVR élevée peut se se développer avec un traitement antipsychotique. Le calculdes indices athérogènes est un bon indicateur du CVR. MOTS CLÉS: Risque cardiovasculaire, Dyslipidémie, Antipsychotiques, Schizophrénie.

Cluster of differentiation 4+ cell count mean value, reference range and its influencing factors in Human Immunodeficiency Virus-seronegative pregnant women in Lagos.

BACKGROUND: Immunity in pregnancy is physiologically compromised and this may affect cluster of differentiation four (CD4) count levels. It is well established that several factors affect CD4 count level in pregnancy. This study aims to determine the effects of maternal age, gestational age, parity and level of education as they influence CD4 count in pregnancy and also to determine the mean and reference range of CD4 count in pregnancy in Lagos, Nigeria. MATERIALS AND METHODS: A descriptive cross-sectional study was carried out at Ante-natal clinics in Lagos State, Nigeria. About 5 mls of blood was collected into Ethylene Diamine Tetracetic Acid (EDTA) bottles from HIV-negative pregnant women in various gestational ages of pregnancy. CD4+ cell count and full blood count of all samples were done within 3 hours of collection. The descriptive data was given as means ± standard deviation (SD). Pearson's chi-squared test and correlation were used for analytical assessment. RESULTS: A total of 74 pregnant women were recruited. The age range was 19-41 years and a mean age of 30.42 ± 5.34 years. The CD4+ cell count was not statistically significant when compared with participants ages P = 0.417, neither with gestational ages P = 0.323, nor with parity P = 0.247 nor level of education P = 0.96. An overall mean CD4+ cell count was 771.96 ± 250 cells/µl and the range was 193-1370 cells/µl. CONCLUSION: Maternal age, gestational age, parity and level of education had no significant effects on CD4+ cell count levels in pregnancy. The mean CD4+ cell count of HIV-negative pregnant women in Lagos is 771.96 ± 250 cells/µl.

Akara Ogbomoso: microbiological examination and identification of hazards and critical control points.

Akara Ogbomoso was examined toward the establishment of hazard analysis and critical control point (HACCP). The akara was produced in residential buildings with the attendant consequence of contamination. There was ample growth of aerobes, coliforms, staphylococci, Shigella and yeast/mold from the samples, water and cowpea pastes. Microbial contaminations occur through the processing, which can be corrected through education by adopting good hygienic and manufacturing practices. The critical control points were identified as frying, storage and refrying. It may be heated in the microwave for 10 s before consumption. Akara, prepared in the laboratory through the implementation of HACCP was not contaminated. Several bacterial isolates, namely; Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, Citrobacter freundii, Serratia marcescens, Proteus vulgaris, Bacillus cereus, Streptococcus pyogenes, Bacillus sp. and Shigella sp., showed multiple resistance to antibiotics ranging from two to nine. Seven strains were not resistant to the antibiotics, while five were resistant to one type of antibiotic.

A politico-medical perspective of induced abortion in a semi-urban community of Ile-Ife, Nigeria.

This study is designed to document a semi-urban community perspective on induced abortion in Ile-Ife, Nigeria, with a view to estimating community awareness, attitudes and implications of its existence in the community and providing relevant sociopolitical policies and pragmatic educational guidelines for policy makers to solve some of its problems within the Nigerian landscape and beyond. This was a cross-sectional study conducted in April 2000, at Oranfe community in Ile-Ife, South West, Nigeria, which has an estimated population of 5250 inhabitants. We used the survey method with the aid of a well-structured questionnaire. One hundred and eighty residents of the community were sampled as our subjects for this study. We used the cluster random sampling technique. The main outcome measures were the sociodemographic characteristics of the respondents, knowledge, attitude with perceived solutions to the problems of abortion and relationship of the sociodemographic factors to respondents' knowledge and attitude. The respondents were highly literate, as only 18 (11.04%) had no formal education. Eighty-five (52.79%) had good knowledge of abortion while 45 (27.95%) and 31 (19.25%) had fair and poor knowledge, respectively. Thirty-eight (24.05%) respondents felt that the solution to the problems of induced abortion can be obtained through its legalisation; 31 (19.62%) respondents believed that the solution lies in liberalising laws on abortion; provision of safe abortion services was suggested by 30 (18.98%) respondents. One hundred and seven (66.88%) felt that legalisation of abortion will increase its practice while 53 (31.12%) felt that such legalisation will not increase the practice. Similarly, 55 (34.37%) of the respondents emphasised that legalisation would reduce the problems of induced abortion compared with 82 (51.25%) who felt otherwise. One hundred and twenty (73.61%) of the respondents did not believe that the position of the law in Nigeria can stop the practice of induced abortion. Solving the problems of induced abortion in Nigeria requires pragmatic and non-hypocritical sex educational policies, which are widely embracing to sensitise people in the community through public enlightenment programmes.