Scaling up numbers and competency of graduating medical and dental students in Nigeria: Need to improve medical trainers' competency in teaching.

Background: With the increasing medical brain drain in Nigeria, there is a need to train and graduate more doctors to fill in the gaps created to mitigate the effects. To meet this goal, the trainers need to evolve and have the competency to deliver quality training for many more enrollees in medical schools. Aim: This study aimed to gather information about the perception of medical teachers' need to obtain certification in medical education and what this will achieve in scaling up the competency and number of graduating medical doctors. Subjects and Methods: Medical teachers in Nigeria participated in this mixed (quantitative and qualitative) study. Four hundred medical consultants and teachers were randomly selected and sent a semi-structured pre-validated questionnaire; also, a panel discussion was conducted with six medical teachers with other special assignments in universities and postgraduate colleges. Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) 24, differences in proportions were calculated using the Chi-square test, and P values <0.05 were considered significant. Results: Two hundred and thirty-eight (59.5%) participants completed the form, 63 (26.5%) had practiced for <5 years, and 114 (47.9%) had >10 years of practice experience. A majority of 168 (70.6%) were physician lecturers in federal or state universities, and 15.5% had obtained certifications of any kind in medical education. Over 80% perceived that medical education training should not be a prerequisite to teach, but a similar percentage believed that faculty medical education training can help scale up the training competency and the number of graduating medical doctors. Conclusion: To scale up the number and competency of graduating medical doctors, medical teachers need to acquire core teaching competency. The respondents and discussants believe that when these core teaching competencies have been fully developed, it will be easier to increase the number of medical students' enrollees, teach them their curriculum through innovations, and graduate them with improved competencies.

Association between cholera treatment outcome and nutritional status in children aged 2-4 years in Nigeria.

SETTING: Cholera can aggravate or precipitate malnutrition, and children with severe acute malnutrition (SAM) have a higher incidence and longer duration of diarrhoea. OBJECTIVE: To describe 1) characteristics of and treatment outcomes in children aged 2-4 years with cholera, 2) the case fatality rate (CFR) in all children treated, and 3) the associations between nutritional status, hydration status, treatment administered and hospital outcomes. DESIGN: An observational cohort study of children admitted to one cholera treatment centre in Maiduguri, Nigeria, with a focus on children aged 2-4 years. CFRs were examined by cross tabulation and mean length of stay (LOS) using analysis of variance. RESULTS: SAM was identified in 24% of children aged 2-4 years. The CFR for children aged 2-4 years was 1.4%. As the sample size was small, we did not find any association between nutritional status and death due to cholera. The proportion of children discharged within 2 days was 79%, and the longest stay was 8 days. In general, health facility LOS increased with severity of malnutrition. CONCLUSION: Our study found that nutritional status affected the LOS, but was unable to find an association between malnutrition and fatality among children aged 2-4 years.

CONTEXTE: Le choléra peut aggraver ou précipiter la malnutrition et les enfants atteints de malnutrition aiguë grave (SAM) ont une incidence plus élevée et une durée plus longue de diarrhée. OBJECTIF: Décrire 1) les caractéristiques et les résultats du traitement d'enfants de 2­4 ans atteints de choléra, 2) le taux de mortalité de tous les enfants traités, et 3) les associations entre état nutritionnel, hydratation, traitement administré et évolution à l'hôpital. SCHÉMA: Cohorte d'observation d'enfants admis au centre de traitement du choléra de Maiduguri, Nigeria, avec un focus sur les enfants de 2­4 ans. Les taux de létalité ont été examinés par tabulation croisée et la durée moyenne de séjour par analyse de la variance. RÉSULTATS: Une SAM a été identifiée chez 24% des enfants de 2­4 ans. Le taux de létalité des enfants de 2­4 ans était de 1,4%. La petite taille de la population n'a pas permis d'observer d'association entre état nutritionnel et décès dû au choléra. La proportion d'enfants sortis en 48h a été de 79% et la durée la plus longue de séjour de 8 jours. En général, la durée de séjour en structure de santé augmentait avec la gravité de la malnutrition. CONCLUSION: Notre étude a constaté que l'état nutritionnel affectait la durée de séjour mais n'a pas permis de trouver une association entre malnutrition et létalité parmi les enfants de 2­4 ans.

Orthopantometric Assessment of Mandibular Parameters in a Sub-Population of Yorubas: A Study of 2 Tertiary Hospitals in South-Western Nigeria.

BACKGROUND: Considerable racial, gender and age differences exist in mandibular parameters, hence anthropometric analyses have evolved to be an important scientific tool in forensic medicine and medico-legal issues. AIMS: The purpose of this study was to determine the mandibular parameters (bilateral gonial angle/ ramus height and the bigonial width) in a sub-population of adult Yorubas with normal occlusion in south western part of Nigeria. METHODS: This was a retrospective study of digital panoramic radiographs (Planmeca ProMax®) of 116 subjects that had routine panoramic radiographic investigation done between January 2015 and June 2020 at two teaching hospitals. Angular and linear measurements of the mandible were made and values obtained analyzed for gender differences. RESULTS: The gonial angle for males (118.08o ) was lower than that for females (118.87o ) but this difference was not statistically significant ( p= 0.3742) while the ramus height and bigonial width for males (61.22mm and186.63mm respectively) were higher than that for females (57.06mm and 179.23 mm) which were statistically significant (p < 0.001 and p < 0.001 respectively). CONCLUSION: Males have statistically significant longer ramus height and bigonial width when compared with females. These finding may be useful in gender determination, however, further studies are recommended. KEY MESSAGES: Males have statistically significant longer ramus height and bigonial width when compared with females in the population studied, hence ramus height and bigonial width in combination with other parameters are useful parameters in studies on gender dimorphism.

CONTEXTE RÉSUMÉ: Des différences considérables de race, de sexe et d'âge existent dans les paramètres mandibulaires, d'où l'évolution des analyses anthropométriques pour devenir un outil scientifique important dans la médecine légale et les questions médico-légales. OBJECTIFS: Le but de cette étude était de déterminer les paramètres mandibulaires (angle gonial bilatéral/hauteur de branche et largeur bigoniale) dans une sous-population de Yorubas adultes avec une occlusion normale dans la partie sud-ouest du Nigeria. MÉTHODES: Il s'agissait d'une étude rétrospective de radiographies panoramiques numériques (Planmeca ProMax®) de 116 sujets ayant subi une exploration radiographique panoramique de routine entre janvier 2015 et juin 2020 dans deux hôpitaux universitaires. Des mesures angulaires et linéaires de la mandibule ont été effectuées et les valeurs obtenues ont été analysées pour les différences entre les sexes. RÉSULTATS: L'angle gonial des mâles (118,08o ) était inférieur à celui des femelles (118,87o ) mais cette différence n'était pas statistiquement significative (p = 0,3742) tandis que la hauteur de la branche et la largeur bigoniale pour les mâles (61,22 mm et 186,63 mm respectivement) étaient plus élevés que ceux des femmes (57,06 mm et 179,23 mm) qui étaient statistiquement significatifs (p < 0,001 et p < 0,001 respectivement). CONCLUSION: Les mâles ont une hauteur de ramus et une largeur bigoniales plus longues statistiquement significatives par rapport aux femelles. Ces résultats peuvent être utiles dans la détermination du sexe, cependant, d'autres études sont recommandées. WAJM 2021 ; 38(6) : 561­565. MESSAGES CLÉS: Les mâles ont une hauteur de ramus et une largeur de bigonie statistiquement plus longues que les femelles dans la population étudiée, donc la hauteur de ramus et la largeur de bigonial en combinaison avec d'autres paramètres sont des paramètres utiles dans les études sur le dimorphisme de genre. MOTS CLÉS: Angle gonial, paramètres mandibulaires, hauteur de branche, largeur bigoniale, Yoruba.

Substance use among adolescents in sub-Saharan Africa: a systematic review and meta-analysis

Background. In sub-Saharan Africa, substance use among adolescents has continued to be a major public health concern, albeit poorly documented across many settings. Objective. To estimate the prevalence of substance use among adolescents in sub-Saharan Africa. Methods. We searched Pubmed, EMBASE, AJOL and Google Scholar for population-based studies on adolescents (age 10 - 19 years) and reporting on the prevalence of substance use across sub-Saharan Africa. Search dates were from January 2000 to December 2016. A random effects meta-analysis was conducted with pooled prevalence rates (and 95% confidence interval (95% CI)) of estimated substance abuse among adolescents in sub-Saharan Africa. Results. Twenty-seven studies across sub-Saharan Africa including 143 201 adolescents (mean age 15.6 years) were selected. The overall prevalence of 'any substance use' in sub-Saharan Africa was 41.6%, with the highest rate in Central Africa at 55.5%. The use of caffeine-containing products (including coffee or kola nut) was most predominant at 41.2% (95% CI 24.3 - 58.1) but limited to West Africa. These were followed by alcohol at 32.8% (95% CI 26.0 - 39.5), tobacco products 23.5% (95% CI 17.7 - 29.3), khat 22.0% (95% CI 12.5 - 31.5) and cannabis 15.9% (95% CI 12.2 - 19.1). Other abused substances included depressants at 11.3% (95% CI 6.5 - 16.1), amphetamines 9.4% (95% CI 6.0 - 12.9), heroin 4.0% (95% CI 3.5 - 4.5) and cocaine 3.9% (95% CI 1.4 - 6.5). Conclusion. Our study reflects a high use of psychoactive substances and drugs among adolescents in sub-Saharan Africa. It is important that interventions and rehabilitation programmes are comprehensive and targeted at adolescents and parents in these settings

SURGICAL AND ORTHODONTIC TREATMENT METHODS IN PATIENTS WITH BIMAXILLARY PROTRUSION - A SYSTEMATIC REVIEW.

BACKGROUND: The acceptable goal of treatment of bimaxillary protrusion is the retraction of maxillary and mandibular incisors with a resultant decrease in soft tissue convexity. This can be achieved by both surgical and orthodontic treatment methods. The aim of this study was to conduct a systematic literature review on the outcome of either method and other associated factors. METHODOLOGY: Electronic databases (PubMed, Cochrane, Medline) were searched to identify studies that assessed hard and soft tissues changes in patients treated for bimaxillary protrusion with surgery or orthodontics. Abstracts that appeared to fulfill the initial selection criteria were selected, and the full-text original articles were retrieved and analyzed. Only articles that fulfilled the final selection criteria were finally considered. Their references were also hand-searched for possible missing articles from the database searches. RESULTS: The initial literature search identified 215 articles while 71 full text articles were retrieved for further analysis. Twenty-four publications were included in the final review. Most of the studies were retrospective with no randomized control trial. The studies showed high heterogeneity in type and technique of space closure, anchorage, orthodontic appliance and surgery. Surgical treatment was carried out for more severe cases than orthodontic treatment. Both methods achieved increased inter-incisal angle, however shorter treatment time appeared to be associated with surgery. CONCLUSION: Satisfactory outcome were achieved with both treatment protocols. However, surgery was more indicated in severe cases.

Giant parotid pleomorphic adenoma in a Nigerian male.

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, accounting for up to 60% of all tumors of the salivary gland and 75-80% of all parotid tumors. It has a slow but progressive growth pattern and if untreated can become greatly enlarged in size. However, giant PA is uncommon. We report a case of giant parotid PA of more than 10 years duration in a 60-year-old male Nigerian. A 60-year-old male patient with 10-year history of painless, massive, and pedunculated swelling in the left side of lower face measuring 25 cm × 23 cm × 17 cm in dimension. Computerized tomographic scan and percutaneous fine needle aspiration cytology returned a preliminary diagnosis of PA. Superficial parotidectomy with facial nerve preservation via the transcervical approach was performed. The excised mass weighed 5.5 kg while the postoperative healing was satisfactory. Benign PAs may attain a giant size if left untreated. Socioeconomic problems are some of the reasons for late presentation. Adequate excision of the tumor sparing the facial nerve is possible but intraoperative and reactionary hemorrhage are likely complications.

Some Adverse Effects of Used Engine Oil (Common Waste Pollutant) On Reproduction of Male Sprague Dawley Rats.

AIM: Used oil is contaminated not only with heavy metals but also with polycyclic aromatic hydrocarbons (PAHs) that are insignificant in the unused oil. In our study we determined possible reproductive effects of used engine oil on male rats. MATERIAL AND METHODS: Twenty eight male Wistar rats were used for the study. The rats had average weight of 181.5 ± 10 g, animal feeds and portable water was provided ad-libitum. The rats were assigned to 4 groups (n = 7) including control. The treated groups orally received 0.1 ml/rat, 0.2 ml/rat and 0.4 ml/rat of the used engine oil every other day for 28 days using oral canulla. The spermatozoa were collected from epididymis for sperm analysis and testes were removed and preserved in Bouin's fluid for routine histological analysis. RESULTS: Our results showed that there was progressive weight increase among the control group of rats that received distilled water. Meanwhile, rats that received 0.4 ml/rat of the used engine oil showed significant (P < 0.05) weight loss in second and third week of administration while rats that received 0.2 ml/rat and 0.1 ml/rat of the used engine oil showed non-significant (P > 0.05) weight reduction. The spermatozoa number was decreased with significance (P < 0.05) at 0.2 ml/rat (2.38 ± 0.29) and 0.4 ml/rat (1.98 ± 0.08) when compared with the control (5.00 ± 0.89). However, the percentage of motile sperms was reduced significantly (P <0.05) at 0.2 ml/rat (52.86 ± 3.59) and 0.4 ml/rat (45.71 ± 2.94) except at 0.1 ml/rat where the reduction (64.00 ± 7.5) was not significant (P> 0.05). The percentage of head deformity been 41.43 ± 2.61 and 42.00 ± 3.74 at 0.2 ml/rat and 0.4 ml/rat respectively, also significant increase of middle piece deformity was observed only at 0.1 ml/rat (45.71 ± 2.02) while tail deformity significantly decreased (15.71 ± 2.02, 20.00 ± 4.36 and 20.00 ± 4.47) when compared with the control (30.00 ± 1.29). The testicular seminiferous tubules were slightly degenerated with absence of Lumen. The germinal cell layer consisting of necrosis of spermatogonia and interstitial (Leydig) cells with affected Sertoli cells at different maturation stages. CONCLUSION: Hence, it can be said that there is a negative relation between used engine oil and male reproductive parameters. And it can be concluded that used engine oil should be prevented from leaking, spilling or improperly discarded as through medium it may enter storm water runoff and eventually affect the environmental health receiving water bodies.

Burnout among doctors in residency training in a tertiary hospital.

The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29-0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28-14.81; p<0.001]. Absence of doctor-to-doctor conflict negatively predicted burnout in the depersonalization subscale (OR=0.36; 95%CI=0.17-0.76); p<0.01), while older age (OR=0.66; 95%CI=0.47-0.95; p=0.03) and adequate support from the management (OR=0.45; 95%CI=0.22-0.90; p=0.02) constituted negative predictors of burnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.

Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria.

BACKGROUND: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. MATERIALS AND METHODS: A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. RESULTS: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). CONCLUSION: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.

Preparation of platelet-rich plasma from small volume of whole blood - a simplified approach.

AIM AND OBJECTIVES: Platelet-rich plasma (PRP) is frequently used to enhance wound healing in numerous surgical applications. There are many methods of preparation of PRP. The present report describes a laboratory technique which is rapid, simple and inexpensive for preparing PRP from small volume of whole blood. MATERIALS AND METHODS: Whole blood was drawn from 30 patients undergoing oral and maxillofacial surgery. PRP was prepared by the modified open system. Platelet counts for whole blood and PRP were determined using a cell counter. RESULTS: The data from 30 patients aged 20 to 33 years, with a mean of 24.4 (± 3.3) and male : female ratio of 1:1.1, were analysed. The platelet count in PRP was 3,157,667 ± 984,380 while that in whole blood was 268,667 (± 64,678) platelets /cubic ml, reflecting an 11-fold increase in platelet concentration. No effect of gender or ageing on platelet count was observed. CONCLUSION: This study demonstrates a simple, rapid and inexpensive technique that is useful in obtaining platelets concentrated approximately 11-fold.

Factors associated with anxiety disorders among HIV-positive attendees of an HIV clinic in Lagos, Nigeria.

Anxiety disorders (ADs) occurring in people living with HIV/AIDS (PLWHA) are often poorly identified in spite of the untold consequences that may result if not diagnosed and treated promptly. This study aimed to describe factors associated with ADs among PLWHA. Three hundred participants were administered sociodemographic/clinical profile questionnaires, and diagnoses of ADs were made using Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based on International Classification of Diseases, 10th edition (ICD-10) criteria. In this study, 65 (21.7%) participants were diagnosed with ADs. A lack of family support, unemployment, younger mean age and being unmarried (P < 0.05) were factors associated with ADs in PLWHA; however, lack of family support (odds ratio [OR] = 0.458, 95% confidence interval [CI] = 0.254-0.827, P = 0.010), being unmarried (OR = 1.930, 95% CI = 1.046-3.560, P = 0.035) and unemployment (OR = 0.495, 95% CI = 0.264-0.926, P = 0.028) were the only factors that remained significant following logistic regression analysis. Prompt identification with active management of ADs and their associated factors among PLWHA are advocated. Further research on the risk factors for ADs is also warranted.

Antibacterial compounds from the mushroom Ganoderma colossum from Nigeria.

Three colossolactones (colossolactone E, colossolactone B and 23-hydroxycolossolactone E) were isolated and characterized from an n-hexane:dichloromethane (2:7) extract of Ganoderma colossum using chromatographic techniques. The antimicrobial activity of the three compounds was then tested against Gram-positive and Gram-negative bacteria. The activity was evaluated by the thin-layer chromatography agar overlay method. The results showed that colossolactone E and 23-hydroxycolossolactone E were active against Bacillus subtilis and Pseudomonas syringae. Colossolactone B was not active against the bacteria. Their structures were elucidated by spectroscopic methods. Potency of the compounds against bacteria tested supports the use of this mushroom in therapeutic medicine.

Perception of dentine hypersensitivity and its management by a group of Nigerian dentists.

BACKGROUND: Dentists need to be aware of the management of dentine sensitivity in view of its high prevalence. OBJECTIVE: The study is to determine by questionnaire the perception of dentine hypersensitivity (DH) and its management by Nigerian Dentists. METHOD: A structured questionnaire was used to collect data from 176 Nigerian Dentists who attended professional dental workshops in Lagos, Ife and Jos, Nigeria. RESULTS: The majority (73.3%) of the responding dentists claimed to see patients with DH. Nearly half (45.1%) of the dentists mentioned cold as the commonest stimulus evoking pain in DH while 56.8% could correctly identified the hydrodynamic theory as the commonest theory of tooth hypersensitivity. Multifactorial aetiology identified as causing DH included tooth wear lesions, periodontal causes and bruxism. Treatment options suggested varies but non-invasive was mentioned more than the invasive techniques. Sensodyne toothpaste was the commonest desensitising paste mentioned. The knowledge of Nigerian Dentists was found to be associated with the specialty of the practitioners (p = 0.0004). CONCLUSION: Dental Practitioners, especially the General Dental Practitioners should be enthusiastic in updating their knowledge of DH and the management. Prevention of DH by the Patients and the Dentists should be emphasised.

Impaired hypoglycaemia awareness and employment in people with Type 1 diabetes.

BACKGROUND: Impaired awareness of hypoglycaemia (IAH) is common in adults with Type 1 diabetes mellitus (T1DM) and is a major risk factor for severe hypoglycaemia. Little is known about its effect on employment status. AIMS: To examine the effect that IAH has on the employment status or employability of people with T1DM. METHODS: A randomly selected cohort of adults of employment age with T1DM completed a questionnaire detailing the history of their diabetes, their occupational history (including job and industry type) and assessing both their hypoglycaemia awareness status and whether in their view their ability to obtain or retain employment had been adversely affected by having diabetes. RESULTS: A total of 252 patients participated, with the following characteristics: 135 males, mean HbA1c 8.5% [standard deviation (SD) 1.4], mean age 43.3 years (SD 13.2), mean duration of diabetes 21.3 years (SD 12.8) and prevalence of IAH 23.4%. The employment rate was comparable between those with preserved awareness (73%) and the IAH group (66%) (not significant). People with IAH were older (P < 0.05) and also more commonly felt that having diabetes affected their ability to work (P < 0.05). CONCLUSIONS: This study is the first to demonstrate that those with T1DM and IAH remain as economically active as those with normal awareness of hypoglycaemia, although subjects with IAH were significantly more likely to feel that having diabetes had adversely affected their capacity for employment.

Lymphoedema of the lower limbs: management problems in a developing country.

BACKGROUND: Lymphoedema is a clinical condition involving the extremities that is characterized by accumulation of protein rich fluid within the intercellular space of the skin and the subcutaneous tissue. It most frequently occurs in the extremities. Developing countries are mostly faced with cases of secondary lymphoedema where patients present lately. In addition to swollen limbs, there are lot of skin changes on the affected limb, these create a lot of problems to the managing clinician. We hereby present five cases out of several patients managed to highlight the challenges. METHODS: We review the case notes of three patients managed by our unit and present the summary of each patient. RESULT: Majority of our patients present late to the hospital, mainly because of the socio-cultural and spiritual beliefs concerning the aetiology of the condition. Most of them have visited the spiritualist, herbalist and the clergymen for solution. Clinicians in the developing countries are seriously handicapped by lack of modern equipment for both diagnostic and therapeutic management of these clinical conditions. CONCLUSION: Chronic lymphoedema is a major cause of permanent disability. Excisional surgery such as Charles procedure even though old is still very much relevant in our environment. Patients need to be enlightened on the need for early presentation, adequate post-operative care and prolonged follow-up.

Description of a chronic heart failure service model and review of pharmacotherapy in a district general hospital in comparison to Scottish Intercollegiate Guideline Network (SIGN) guidelines.

BACKGROUND: The Scottish Intercollegiate Guidelines Network (SIGN) guideline 95 on the management of chronic heart failure (CHF) was published in February 2007, superseding SIGN guideline 35 of February 1999. The guideline promotes evidence based management of CHE. AIMS: To describe an existing service model and to review our level of concordance with SIGN guidelines. METHODS: We describe a model of a CHF service based in a district general hospital (DGH) in Scotland. We conducted a retrospective review on consecutive new referrals between August and November 2002, and a prospective review of new attendances between September 2005 and January 2006. RESULTS: In 2002 and 2005/6, 49 and 45 patients were reviewed respectively, with 26 and 28 patients showing left ventricular systolic dysfunction on echocardiography. Median ages of patients were 81 and 79 years respectively. Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin II Receptor Blocker (AIIRB) therapy was in use in 23 (88.5%) and 24 (85.7%) patients respectively. The use of beta-blockers, digoxin and spironolactone was shown to have improved between both reviews. CONCLUSIONS: We have been able to demonstrate an improving level of concordance with SIGN guidelines in a district general hospital (DGH) heart failure service model run by care of the elderly physicians and supported by specialist nurses.

Bacterial infections of the head and neck fascial spaces in Nigerians.

BACKGROUND: Bacterial infections of the head and neck region remain a major public health concern in Nigeria despite the availability and widespread use of antibiotics in the country. OBJECTIVE: This study was conducted to determine the pattern, aetiology, management and outcome of head and neck fascial space infections at Ife. METHODS: All consecutive patients who presented with fascial space infections between January 1995 and July 2004 at the Maxillofacial Unit of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria were admitted into the study. A structured questionnaire was completed for each patient and analyzed in respect of patients' demographics, source of infection, predisposing factors, location of infection; treatment and outcome. RESULTS: One hundred and three patients were managed during the study period. There were 55(53.4%) males and 48(46.6%) females with age ranging from 1-85 years. Submandibular space was the most common single space involved followed by the buccal space. The fascial spaces around the mandible were more involved those around the maxillae and scalp for all age groups. Four patients presented with Ludwigs' angina. Odontogenic infections arising from pulpitis, periodontitis and pericoronitis caused over 70% of the space infections. Microbial cultures showed mixed aerobic and anaerobic bacteriology. Management was by incision and drainage/decompression, removal of the source, use of antibiotics and supportive care. Two deaths were recorded in the course of this study. CONCLUSION: Bacterial infections of the head and neck region remain a major health hazard among Nigerians with spread of infection commonly involving the submandibular and the buccal spaces.

Prevalence of overweight and obesity in Eti-Osa LGA, Lagos, Nigeria.

In many of the urban centres of the developing countries, a change in lifestyle due to increased affluence has been observed. It has been shown that change in lifestyle is an important factor in the global epidemic of overweight and obesity. The aim of this study was to assess the influence of lifestyle and socioeconomic class on the prevalence of overweight and obesity amongst adolescents from rural and urban centres in Lagos, Nigeria. This is a cross-sectional prospective survey carried out on a sample of 1504 randomly selected adolescents, aged between 10 and 19 years, from six public secondary schools located in urban and rural areas of the Eti-Osa local government area of Lagos State, Nigeria. A self-designed completed questionnaire was used to determine the participants' socio-demographic characteristics. Anthropometric measurements were taken to calculate their body mass index (BMI). The overall prevalence rates of overweight and obesity in the urban and rural areas, respectively, were 3.7% and 0.4%, and 3.0% and 0.0%. Socioeconomic class did not significantly affect the BMI values. Overweight is an evolving problem, while obesity is seemingly not a problem yet in adolescent school-aged children in Lagos State, Nigeria.

Toxicological studies on the purified protoberberine alkaloidal fraction of Enantia chlorantha Oliv (ANNONACEAE).

We have examined the cumulative effects of the protoberberine alkaloidal fraction (AF) of the stein bark ethanolic extracts of Enantia chlorantha on some body tissues and organs as well as on certain biochemical and metabolic parameters in mice. Acute and sub-chronic toxicity studies of the alkaloidal fractions of Enantia chlorantha were carried out in 120 mice using oral and intraperitoneal administrations. Fatality was not recorded in mice injected intraperitonealy with 100 mg kg(-1) and 150 mg kg(-1) dose level but larger doses resulted in death and the mean lethal dose (LD50) toxicity studies showed neither behavioural/untoward reactions nor death in any of the animals. The histopathological examination of the test animals when compared with the control revealed that, the sub-chronic use of the alkaloidal fractions does not have any pathological effects (lesion) on the organs examined (the stomach, the kidney, the oesophagus and the liver) except the lungs which showed mild and moderate oedema. The biochemical and metabolic analysis of the mice plasma did not show any significant difference when the corresponding values for the test mice were compared with the control mice (P > 0.05) at the end of the 14 days treatment using both 20 mg kg(-1) and 2 mg kg(-1) dose levels. The results obtained in this study suggest the relative safety of short-term use of preparations containing E. chlorantha, a very popular antimalarial herbal remedy in Southern Nigeria.

Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians.

At a Nigerian university hospital, none of the motorcyclists who presented over a 12 month period had been wearing a helmet, and of the eight patients who died, seven had head injuries. Of the five collision types described, the rate of motorcycle-other vehicle collisions was highest at 40.6%, while the motorcycle-pedestrian rate was 23.4%. Measures to prevent these collisions might reduce overall crashes by 64%; in addition, helmet law should be enforced.