DEMOGRAPHICS OF COLLABORATORS INVESTIGATING THE NIGERIAN MEDICAL AND DENTAL INTERNS: A MEDICAL INTERNSHIP TRAINING IN NIGERIA (MINTING) STUDY COLLABORATION.

Introduction: The internship period is a peculiar time in a doctor's career, and some have described it as a "nuisance year" during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria. Methodology: A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study. Results: Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative. Conclusion: This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCN collaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force.

Willingness to support antenatal blood donation among married men in a Metropolitan City in North-central Nigeria.

AIMS AND OBJECTIVES: Improving blood availability through voluntary or compulsory antenatal blood donation is pivotal to reducing maternal morbidity and mortality in developing countries. Willingness to donate blood is adjudged to be an important step to the actual practice of donating blood. This study aimed to determine the knowledge, attitude and willingness of men towards antenatal blood donation. PATIENTS AND METHODS: This was a descriptive cross-sectional study. A multi-stage sampling technique was used to recruit 500 married men into the study using interviewer-administered questionnaire. Data analysis was done using SPSS version 16 software package. Pearson's Chi-squared test was used to test for significant associations between variables. A P < 0.05 was considered as statistically significant. RESULTS: More than half 300 (60%) of the respondents had good knowledge of antenatal blood donation in general. Majority (85.8%) of the respondents were willing to support voluntary blood donation. The overall attitude to blood donation was positive in 77.8% of the respondents. A significantly higher proportion 268 (89.3%) of respondents with good knowledge of antenatal blood donation were willing to donate blood (P = 0.0006). CONCLUSIONS: The majority have good knowledge and positive attitude towards antenatal blood donation. However, there is need to urgently transform this positive attitude to action through continual public enlightenment to reduce maternal morbidity and mortality.

Effect of kolaviron, a biflavonoid complex from Garcinia kola seeds, on the antioxidant, hormonal and spermatogenic indices of diabetic male rats.

The antihyperglycaemic effect of kolaviron (KV), a biflavonoid from Garcinia kola has been established in previous studies. In this study, we investigated the effect of KV (200 mg kg(-1) ) on the antioxidant, hormonal and spermatogenic indices of alloxan-diabetic male rats, and metformin hydrochloride (MET) (30 mg kg(-1) ) served as standard drug. The results showed that KV and MET significantly (P < 0.05) decreased the fasting blood glucose of the diabetic rats. Also, untreated and MET-treated diabetic groups had significantly (P < 0.05) lower body-weight gain and relative weights of testes. In addition, epididymal sperm abnormalities were increased, whereas sperm count, motility, testicular protein and sialic acid were decreased in untreated diabetic group. Also, antioxidant parameters, reduced glutathione, catalase, superoxide dismutase, glutathione-S-transferase and glutathione peroxidase were significantly (P < 0.05) reduced in the testes with a concomitant increase in lipid peroxidation in untreated diabetic group. Furthermore, untreated diabetic group had significantly (P < 0.05) lower levels of testosterone, luteinising and follicle-stimulating hormones relative to controls. Treatment with KV restored the relative weights of testes, activities of antioxidant enzymes, sperm and hormonal indices of the diabetic animals. This study demonstrated the role of KV to promote fertility in diabetic male rats by enhancing the hormonal and antioxidant status of the rats.

Effects of α-tocopherol and ascorbic acid in the severity and management of traumatic brain injury in albino rats.

BACKGROUND: Traumatic brain injury (TBI) is accompanied by substantial accumulation of biomarkers of oxidative stress and depletion of antioxidants reserve which initiate chain reactions that damage brain cells. The present study investigated the role of ascorbic acid and α-tocopherol on the severity and management of TBI in rats. MATERIALS AND METHODS: Wistar rats were subjected to closed head injury using an accelerated impact device. Rats were administered 45 mg/kg and 60 mg/kg body weight of ascorbic acid, α-tocopherol or a combination of the two vitamins for 2 weeks pre- and post injury. Blood and brain tissue homogenates were analyzed for vitamin C, vitamin E, malondialdehyde, superoxide dismutase, and creatine kinase activities. RESULTS: The results indicated that TBI caused significant (P < 0.05) decreased in vitamins C and E levels in the blood and brain tissue of TBI-untreated rats. The activities of superoxide dismutase in TBI rats were markedly reduced when compared with non traumatized control and showed a tendency to increased following supplementation with vitamins C and E. Supplementation of the vitamins significantly (P < 0.05) reduced malondialdehyde in the treatment groups compared with the TBI-untreated group. CONCLUSION: The study indicated that pre and post treatment with ascorbic acid and α-tocopherol reduced oxidative stress induced by brain injury and effectively reduced mortality rate in rats.

Serum levels of antioxidant vitamins and mineral elements of human immunodeficiency virus positive subjects in Sokoto, Nigeria.

BACKGROUND: Undernourishment and micronutrient deficiencies exacerbate immunosuppression, oxidative stress, acceleration of human immunodeficiency virus (HIV) replication and CD4 T-cell depletion in HIV-infected individuals. MATERIALS AND METHODS: The current work reports the serum levels of antioxidant vitamins (vitamins A, C and E) and minerals (Zn, Fe, Cu) in 90 HIV positive subjects attending the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The serum levels of the micronutrients were correlated with the CD4 count of the subjects. RESULTS: The results showed that the HIV positive subjects have significantly lower (P < 0.05) levels of vitamins A, C and E. Also, serum Zn, Fe, Cu and CD4 count were also significantly (P < 0.05) lower compared with the HIV negative subjects. Micronutrient deficiencies were more pronounced in HIV positive subjects with CD4 counts less than 200 cell/µl. The results based on age and sex showed no significant (P > 0.05) difference. Vitamins A, E and C and Zn and Fe showed positive correlation with CD4 count of the HIV positive subjects. CONCLUSION: The results suggest that the HIV subjects in the study area have lowered serum levels of antioxidant micronutrients and that the levels decrease with increase in the severity of the infection. These may increase the chances of the symptomatic and asymptomatic subjects progressing into full-blown Acquired Immunodeficiency Syndrome.

Serum levels of antioxidant vitamins and mineral elements of human immunodeficiency virus positive subjects in Sokoto, Nigeria

Background: Undernourishment and micronutrient deficiencies exacerbate immunosuppression, oxidative stress, acceleration of human immunodeficiency virus (HIV) replication and CD4 T-cell depletion in HIV-infected individuals. Materials and Methods: The current work reports the serum levels of antioxidant vitamins (vitamins A, C and E) and minerals (Zn, Fe, Cu) in 90 HIV positive subjects attending the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The serum levels of the micronutrients were correlated with the CD4 count of the subjects. Results: The results showed that the HIV positive subjects have significantly lower (P < 0.05) levels of vitamins A, C and E. Also, serum Zn, Fe, Cu and CD4 count were also significantly (P < 0.05) lower compared with the HIV negative subjects. Micronutrient deficiencies were more pronounced in HIV positive subjects with CD4 counts less than 200 cell/ìl. The results based on age and sex showed no significant (P > 0.05) difference. Vitamins A, E and C and Zn and Fe showed positive correlation with CD4 count of the HIV positive subjects. Conclusion: The results suggest that the HIV subjects in the study area have lowered serum levels of antioxidant micronutrients and that the levels decrease with increase in the severity of the infection. These may increase the chances of the symptomatic and asymptomatic subjects progressing into full-blown Acquired Immunodeficiency Syndrome

Thyroid diseases in pregnancy: a review.

OBJECTIVE: To provide an overview of the pathophysiology of thyroid diseases in pregnancy and the various treatment methods currently available in its management. DATA SOURCE: Review of literature was affected through index medicus search of major published journals and books. DATA SELECTION: Published data on thyroid diseases on women in the reproductive age group over the last four decades were utilised. DATA EXTRACTION: Abstracts and full text of selected manuscripts were read and analysed to determine their contribution to this article. DATA SYNTHESIS: All relevant articles were reviewed and contributions extracted. CONCLUSION: Thyroid diseases are the second most common endocrinopathies in pregnancy. Numerous hormonal changes and metabolic demands occur in pregnancy resulting in complex changes in maternal thyroid function. Thyroid diseases involves a multidisciplinary team approach to achieve good metabolic control and excellent obstetric care in order to ensure normal maternal and perinatal outcome.

Diagnostic potentials of the activities of lectins with whole cells of three bacterial diarrheagenic agents: Aeromonas, Plesiomonas, Campylobacter.

The reactiviteisofstrains ofPlesionmona shigeloides, Campylobater jejuni, Campylobacter coli and Aeromonas species with some lectins namely Soyabean agglutinin (SBA), Ricinus communis agglutinin (RCA), Peanut agllutinin (PNA), Cancanavalin-A (Con-A), Lima bean agglutinin (LMA) and Abrin were investigated using the microtitre plate method. The results obtained show that all stains of A. hydrophila, A. caviae, A. Sobria and P. shigelloides reacted very strongly with PNA and SBA. All strains of C. jejuni studied failed to react with SBA but reacted with PNA Whereas C. coli did not show any reaction towards PNA but reacted very strongly with SBA. All strains of the different organisms were strongly agglutinated by RCA and LMA except A. Hydrophilia and A. sobria which did not react with RCA and LMA respectively. C. jejuni was not agglutinated by Con-A unlike C. coli. Only C. jejuni, C. coli and P. shigelloides reacted with abrin. This study suggests that the reactivities of lectins with the diarrheogenic bacteria studied may be used for their presumptive identifications and for epidemiological purposes.

Diagnostic Potentials of the Reactivities of Lectins with whole Cells of Three Bacterial Diarrheagenic Agents : Aeromonas; Plesiomonas and Campylobacter

The reactivities of strains of Plesionmona shigeloides; Campylobater jejuni; Campylobacter coli and Aeromonas species with some lectins namely Soyabean agglutinin (SBA); Ricinus communis agglutinin (RCA); Peanut agllutinin (PNA); Cancanavalin-A (Con-A); Lima bean agglutinin (LMA) and Abrin were investigated using the microtitre plate method. The results obtained show that all stains of A. hydrophila; A. caviae; A. Sobria and P. shigelloides reacted very strongly with PNA and SBA. All strains of C. jejuni studied failed to react with SBA but reacted with PNA Whereas C. coli did not show any reaction towards PNA but reacted very strongly with SBA. All strains of the different organisms were strongly agglutinated by RCA and LMA except A. Hydrophilia and A. sobria which did not react with RCA and LMA respectively. C. jejuni was not agglutinated by Con-A unlike C. coli. Only C. jejuni; C. coli and P. shigelloides reacted with abrin. This study suggests that the reactivities of lectins with the diarrheogenic bacteria studied may be used for their presumptive identifications and for epidemiological purposes

Alcohol consumption and heart failure in hypertensives.

Sixty hypertensives (30 with and 30 without heart failure, matched for age and sex) were studied and their alcohol consumption and its possible role in heart failure were assessed. The majority in each group belonged to the low socioeconomic class. On presentation, the mean systolic blood pressures were 176.7 +/- 29.7 and 198.8 +/- 29.8 mmHg and diastolic blood pressures 118 +/- 15 and 118.5 +/- 13.6 mmHg, respectively. In those known to be hypertensive before presentation to our unit, hypertension was first detected 4.88 +/- 3.8 and 4.40 +/- 3.3 years earlier in the heart failure and non-heart failure groups, respectively. Drug compliance was similarly poor in the two groups. Of all 12 drinkers in heart failure, 75% drank heavily, while only 18.2% (two of 11) of the non-heart failure drinkers drank heavily. Nine (30%) and two (6.7%) of the heart failure and the non-heart failure groups, respectively, took > or = 80 g of alcohol daily for at least 3 years (P < 0.02). Significantly more of the heart failure group were thiamine deficient, although the deficiency could not be directly attributed to alcohol. The odds ratio for heavy and moderate alcohol consumption was 5.9 and 0.9, respectively. Thus it is suggested that heavy alcohol consumption appears to be a major contributory factor to heart failure in these patients.

The antibacterial effect of honey on diarrhoea causing bacterial agents isolated in Lagos, Nigeria.

The antibacterial effect of local honey on local isolates of bacterial agents of diarrhoea was determined by an in vitro method involving the impregnation of filter paper discs in undiluted honey and different honey concentrations ranging from 10%-50%. The discs were later placed on plates that have been seeded with the different bacteria and zones of inhibition of growth were measured after a 48 hr. period of incubation. Results presented show that undiluted honey and honey at concentrations of 40% and above were inhibitory to all enteropathogens tested. Zones of inhibition of growth around the disc margin of the various enteropathogens tested ranged from 16-18mm in diameter for the local undiluted honey and 7-12mm in diameter for concentrations of honey at 40% and 50%. The possible mechanisms of this inhibitory effect of local honey are discussed.

A review of referred IUCD related problems in Lagos University Teaching Hospital.

A review of 168 patients referred with IUCD related problems was done. The two most common indications for referrals were difficulty at removal (73.8%) and missing/lost IUCD thread 23.8%. In 22.5% (9) of cases referred as missing/lost IUCD, the threads were visible on inspection of the cervix during speculum examination 21.4% (36) of the referred patients had routine removal by simple traction, while the retrieval hook was successfully used in 75% of the cases, only 3 patients (1.7%) required removal under general anaesthesia. A proper speculum examination combined with uterine sounding and the use of the retrieval hook at the peripheral centres will greatly reduce the need for referring IUCD related cases to a tertiary centre.

Snakebites in poultry.

Eight cases of snakebite involving 5 flocks were seen in chickens, ducks and turkeys in the Avian Ambulatory Clinic of the Veterinary Teaching Hospital, Zaria, between July 1983 and August 1990. Most of the clients resided in areas with large canopies of trees and bushes. There was a large gully just behind the residential areas. Twenty-one birds were bitten; chickens constituted 85.7%, turkeys 12% and ducks 4.8% of this number. Hens incubating eggs were most vulnerable. Cocks were usually bitten when they attacked the snakes. Clinical signs were similar to those reported in other animal species. Gross lesions included congestion of visceral organs and hemorrhage in the viscera, around the bite sites and in the sc tissues. There was also im edema around bite sites. The fatality rate was 87.5%.

Improving the quality of service delivery in Nigeria.

This study evaluates the effect of a nurse training program in family planning counseling skills on the quality of service delivery at the clinic level, as well as its impact on client compliance with prearranged appointments. The study used a quasi-experimental design to compare certified nurses who received six weeks of family planning technical training with certified nurses who, in addition to the technical training course, received a three-day course in counseling skills. Data were collected through client exit interviews, expert observation, and inspection of medical record abstracts. Trained nurses performed better than their untrained counterparts in the quality-of-care areas investigated--interpersonal relations, information giving, counseling, and mechanisms for encouraging continuity. The likelihood that clients will attend follow-up visits was also found to improve when they were attended by trained professionals. Short-term counseling training can significantly improve the quality of care provided by family planning workers, as well as client compliance with follow-up appointments.

PIP: In 1989, researchers evaluated the impact of a 3 day course in counseling and interpersonal communication skills for family planning nurses in Ogun State, Nigeria on quality of service delivery and on client compliance with follow up appointments. They interviewed 480 clients, observed 39 nurses, and examined the medical records of 1001 clients who visited the 8 clinics. 97% of clients who spoke to a trained nurse felt the nurse earnestly listened whereas only 66% of those who spoke with an untrained nurse felt this (p.001). Further clients tended to be more comfortable with trained nurses than with untrained nurses (97% vs. 76%; p.001). Moreover trained nurses provided clear explanations to 94% of clients while untrained nurses did so to only 76% of clients (p.001). In addition, trained nurses were better at demonstrating the use of a contraceptive (p.001), repeating instructions for methods (p.05), asking if clients had more questions (p.05), and referring to booklets or leaflets about methods (p.05). They intended to schedule a follow up visit with clients who used a method for the 1st time (96% vs. 78%; p.001). In fact, clients of trained nurses were 2 times as likely to return than those of untrained nurses (84% vs. 44%; p.001). Moreover, of clients who chose to use the IUD at the 1st visit, 85% of those attended to by a trained nurse returned for follow up appointments compared to only 30% of those attended to by an untrained nurse (p.001). The corresponding percentages for those who chose an oral contraceptive were 91% and 70% p.001). The findings revealed that the training course did indeed improve the quality of family planning service delivery and client compliance. In fact, counseling training most likely provided even greater advantages than the study suggested since untrained nurses interacted with the trained nurses socially and on the job. Moreover they were also inquisitive about what methods their trained colleagues used.

Pericardial effusion associated with minoxidil therapy: case reports.

Symptomatic pericardial effusion (PE) occurred in two of our patients with chronic renal failure (CRF) who had taken minoxidil for control of their hypertension. One of them died from the effects of cardiogenic shock due to cardiac tamponade. The 2 patients had taken minoxidil for over 3 months. Other patients who had CRF had not developed symptomatic PE while being treated with other anti-hypertensive agents. Our experience conforms with reports from elsewhere that minoxidil may cause PE. Therefore, patients with CRF who need minoxidil as an anti-hypertensive agent should be examined regularly for clinical evidence of PE.

Pericardial effusion associated with minoxidil therapy. [case reports]

Symptomatic pericardial effusion (PE) occured in two patients with chronic renal failure (CRF) who had taken minoxidal for control of their hypertension. One of them died from the effects of cardiogenic shock due to cardiac tamponade. This experience conforms with reports from elsewhere that minoxidil may cause PE. Therefore; patients with CRF who need minoxidil as an anti-hypertensive agent should be examined regularly for clinical evidence of PE

Occurrence of Leuconostoc mesenteroides and leuconostoc-like organisms in Lagos, Nigeria.

A total of 91 catalase--negative Gram-positive coccal isolates obtained from 245 clinical specimens in Lagos were characterized. Ten (11.0%) of the isolates were vancomycin resistant, they fermented glucose, sucrose, fructose, lactose, mannose, mannitol, ribose, salicin, sorbitol, arabinose and xylose with acid production. One of the isolates produced in addition gas inclusive and ethanol, thus identified as Leuconostoc mesenteroides. The ten vancomycin-resistant Gram-positive coccal organisms (VRGPC) showed variable sensitivity patterns to penicillin, tetracycline, erythromycin, ampicillin, streptomycin, chloramphenicol, cloxacillin and co-trimoxazole. The possible role of Leuconostoc spp. and VRGPC in clinical infections in hospital setting is still to be defined.

Erythrocyte membrane ouabain-sensitive Na+, K(+)-ATPase of hypertensive Nigerians.

An assessment of the ATPase functions of erythrocyte membrane of newly identified subjects having essential hypertension shows that Na+,K(+)-ATPase activity is higher in normal membranes than in membranes of individuals with essential hypertension. A study of the dependence of the enzyme on ATP in the presence of non-limiting concentrations of Na+ (120 mM) and Mg2+ (3 mM) shows that the pump in the membranes of hypertensive individuals, like that of normal humans, is easily saturable by ATP (greater than or equal to 2 microM). Analysis of the results of kinetic studies on the enzyme, in the presence of 5 mM K+, using the Hanes plot, reveals that, although the affinity (Km) of the pump for ATP is unaffected in essential hypertension, its maximum velocity (Vmax) is lower than in normal membranes. Even though the reason for a reduced sodium pump function in essential hypertension is not yet clear, it may not be unconnected with the presence of an endogenous inhibitor or with genetic or diet-induced membrane defects, as previously proposed by other workers in this area of research.