Camel (Camelus dromedarius) raw milk’s hypotensive roles within chemical induced hypertension model in rats

Dromedary camels (Camelus dromedarius) inhabit not only arid areas but are among common domestic animals that are normally kept for numerous uses. It’s raw milk (CM) is believed to have exceptional nutraceutical value in addition to it’s other uses similar to camel itself. This study aimed to evaluate hypotensive efficacy of raw CM within context of chemical induced hypertension model in albino rats. Rats received the chemical; L-NAME (50 mg/kg body weight/day, p.o.) and amlodipine (10 mg/kg/day, p.o.) as negative and positive controls for 4 weeks. Rats of treatment group received concurrently L-NAME (50 mg/kg body weight /day, p.o.) and raw milk of camel at (100, 300, and 500 mg/kg body weight/day p.o.) respectively for 4 weeks. Result showed significant decrease (p <  0.001) in treatment relative to negative control in all measured parameters viz systolic, diastolic and mean arterial blood pressures in accordance to the used dosages. Also elevated levels of liver/kidney biomarkers in negative control became reduced compared to normal and positive controls courtesy of CM treatment. In conclusion, obtained data revealed CM to be effective in controlling hypertension. The bioactive constituents present in CM appeared likely to be responsible for the observed effect of antioxidant action and ACE inhibition. Evidence is thus provided from research findings that raw CM can afford efficient hypotensive effect.

Clinical audit and research in radiography practice: An exploration of the English landscape

BACKGROUND

Research and clinical audit are central to the quality improvement (QI) process in healthcare; whereas research produces new knowledge, clinical audit establishes if practice is meeting set standards. Thus, radiographers have responsibility to engaging in these QI activities. This study aimed to explore radiographers' understanding, attitudes and level of involvement in clinical research and audit across England.

METHODS

A cross-sectional survey using an online questionnaire for data collection over a 6-week period was employed. The questionnaire consisted of open and closed ended questions. Participants were recruited through social media. The quantitative data obtained was analysed using Statistical Package for Social Sciences (SPSS) Version 26 (IBM Inc, Armonk, NY) whilst content analysis was used to analyse the free-response data.

RESULTS

A total of 100 valid responses were obtained after exclusion of 45 partial and/or incomplete responses. Radiographers showed a positive attitude towards involvement in research and audit with overall mean score of 3.85 (SD 0.80) and 4.01 (SD 0.80), respectively. Of the respondents, 35.7% (n = 35/98) were currently involved in clinical audit projects whilst 78.6% (n = 77/98) have previously been involved. Radiographers with postgraduate degrees were significantly more likely to have initiated research, 61.5% (n = 16/26) (p = 0.01) and to have previously been involved with research, 80.8% (n = 21/26) (p = 0.02). A significant association between radiographers' role and implementation of changes, following an audit (p = 0.03) was noted. Similarly, a significant association was noted between radiographers' role and initiation of research (p = 0.05).

CONCLUSION

Clinical radiographers in England showed a positive attitude towards research and audit. However, this did not translate into actual participation in research and audit activities.

IMPLICATIONS FOR PRACTICE

The need to stimulate clinical radiographers' interest in clinical audit and research is highlighted. Additionally, the findings support the rationale for managers to give more support including protected time to radiographers to engage in QI activities.

Barriers and solutions to effective mentorship in health research and training institutions in Nigeria: Mentors, mentees, and organizational perspectives

Aims and Background

Mentoring relationships and programs have become a subject of global interest and their relevance is high in the ever-evolving health system. In Nigeria, informal system of mentoring is largely practiced. To be able to institutionalize mentoring program, there is need to explore the various challenges of mentoring process and suggest potential approaches for effective mentor-mentee relationship in health research institutions in Nigeria.

Subjects and Methods

The study was designed to explore the barriers and solutions to mentoring process from the perspectives of the mentor, mentee, and organization in health research and training institutions in Nigeria. A cross-sectional descriptive design was employed and the study was conducted among 21 health researchers drawn from 24 health research institutions across the 6 regions of Nigeria. The nominal group technique was adopted in the data collection process.

Results

The most frequently reported mentor challenges were "lack of understanding of mentorship process" (84.2%) and "lack of capacity for mentoring" (78.9%), while those of mentee were "mentor preference" (73.7%) and "lack of freedom of expression" (47.4%). "Culture of selfishness/individualism" (84.2%) and "lack of formal relationship" (63.2%) were the most mentioned systemic challenges. Training on mentoring process and relationship was mentioned as the most frequent approach to overcoming challenges for the three perspectives.

Conclusion

Significant mentorship challenges exist in the Nigerian health, academic and research institution. Systematic approaches to finding and implementing the appropriate solutions are needed to circumvent these bottlenecks.

Prevalence and risk factors for hepatitis c virus co-infection among human immunodeficiency virus-infected patients and effect of hepatitis c virus infection on acquired immunodeficiency syndrome cases at baseline

Background

Hepatitis C virus (HCV) co-infection with human immunodeficiency virus (HIV) exists as both viruses have the common routes of transmission. HIV infection has adverse effect on the natural history of HCV infection; however, the effect of HCV infection on the natural history of HIV infection is unclear.

Materials and Methods

This study was cross-sectional comprising of treatment-naïve adult HIV-infected patients attending clinics at Usmanu Danfodiyo University Teaching Hospital, Sokoto and Specialist Hospital Sokoto. The study participants were screened for HCV anti]body and assayed for transaminases and CD4+ T-lymphocytes count levels. The symptoms of acquired immunodeficiency syndrome (AIDS)-defining illnesses were asked among the study participants. The questionnaire was used for the collection of data, and SPSS software version 20 was used for the analysis of data. Student's t-tests, Pearson's, Chi-square, and Fisher's exact tests were used for the statistical analysis, and P < 0.05 was considered statistically significant.

Results

The prevalence of HIV/HCV co-infection was 20.6%. Self-intravenous drugs usage was not statistically significant (P = 0.210). HIV mono-infected patients had significantly lower alanine aminotransferase levels compared to HIV/HCV co-infected study participants (P = 0.048). AIDS status at the baseline was comparable between HIV mono-infected and HIV/HCV co-infected study participants. (P = 0.227; 0.200; 0.130).

Conclusion

Moderately high prevalence of HIV/HCV co-infection was observed in the current study. HCV co-infection had no effect on AIDS status at baseline. There is a need for routine screening of HCV infection in HIV-infected individuals.

Farmers' choice of genotypes and trait preferences in tropically adapted chickens in five agro-ecological zones in Nigeria

This study aimed at determining chicken genotypes of choice and traits preference in chicken by smallholder farmers in Nigeria. Data were obtained from a total of 2063 farmers using structured questionnaires in five agro-ecological zones in Nigeria. Chi square (χ²) statistics was used to explore relationships between categorical variables. The mean ranks of the six genotypes and twelve traits of preference were compared using the non-parametric Kruskal-Wallis H (with Mann-Whitney U test for post hoc separation of mean ranks), Friedman, and Wilcoxon signed-rank (with Bonferroni's adjustments) tests. Categorical principal component analysis (CATPCA) was used to assign farmers into groups. Gender distribution of farmers was found to be statistically significant (χ² = 16.599; P ≤ 0.002) across the zones. With the exception of Shika Brown, preferences for chicken genotypes were significantly (P ≤ 0.01) influenced by agro-ecological zone. However, gender differentiated response was only significant (P ≤ 0.01) in Sasso chicken with more preference by male farmers. Overall, FUNAAB Alpha, Sasso, and Noiler chicken were ranked 1st, followed by Kuroiler (4th), Shika Brown (5th), and Fulani birds (6th), respectively. Within genotypes, within and across zones and gender, preferences for traits varied significantly (P ≤ 0.005 and P ≤ 0.01). Traits of preference for selection of chicken breeding stock tended towards body size, egg number, egg size, and meat taste. Spearman's rank order correlation coefficients of traits of preference were significant (P ≤ 0.01) and ranged from 0.22 to 0.90. The two PCs extracted, which explained 65.3% of the variability in the dataset, were able to assign the farmers into two groups based on preference for body size of cock and hen and the other ten traits combined. The present findings may guide the choice of appropriate chicken genotypes while the traits of economic importance may be incorporated into future genetic improvement and conservation programs in Nigeria.

Smallholder cattle farmers' breeding practices and trait preferences in a tropical Guinea savanna agro-ecological zone

The present study was embarked upon to determine the breeding practices and choice of selection and breeding traits of cattle farmers in Nasarawa State and the Federal Capital Territory (FCT), Abuja, Nigeria. A total of 180 smallholder cattle herders were randomly sampled. However, analysis of data was restricted to 144 herders (81 from FCT and 63 from Nasarawa State). Primary data were collected through individual structured questionnaire administration. Chi-square (χ2) statistics were used to compare categorical variables. Arithmetic means of continuous variables between locations were tested using T test. Rank means were also calculated for within- and between-location comparisons of the preference traits. Chi-square automatic interaction detection (CHAID) algorithm was used to determine the influence of socio-economic parameters on the traits of preference. Access to credit, personal savings, and type of landholding were significantly (P < 0.05) different between the two locations with higher values recorded for farmers in FCT. However, farmers in Nasarawa State had significantly higher land expanse (2.28 ± 0.19 versus 1.29 ± 0.09). The production objectives were rated similar between locations. The number of foundation stock differed significantly between farmers in the two locations with higher mean recorded in Nasarawa (7.37 ± 0.37) compared to FCT (5.18 ± 0.19). However, mean herd size was higher (34.60 ± 2.58 versus 27.63 ± 2.00; P < 0.05) in FCT than Nasarawa. Among the productivity indices, only average age at first parturition and average calving interval were significantly (P < 0.05) influenced by location. Within the FCT, calving interval was the trait of utmost importance in selecting the breeding stock, followed by milk yield, disease resistance, and body size. In Nasarawa State, calving interval, disease resistance, milk yield, body size, and survival were ranked similarly (P  >0.05). Across the two locations, body conformation (P < 0.05) and calving interval (P < 0.01) were more highly rated in FCT than Nasarawa State, while heat tolerance was less rated (P < 0.05) in the former. All the traits of preference were influenced by socio-economic factors, and could be exploited in future breeding plans to boost cattle production. A new livestock census in the study area is also advocated to reflect the current reality as regards cattle distribution.

Predicting heat stress index in Sasso hens using automatic linear modeling and artificial neural network

There is an increasing use of robust analytical algorithms in the prediction of heat stress. The present investigation therefore, was carried out to forecast heat stress index (HSI) in Sasso laying hens. One hundred and sixty seven records on the thermo-physiological parameters of the birds were utilized. They were reared on deep litter and battery cage systems. Data were collected when the birds were 42- and 52-week of age. The independent variables fitted were housing system, age of birds, rectal temperature (RT), pulse rate (PR), and respiratory rate (RR). The response variable was HSI. Data were analyzed using automatic linear modeling (ALM) and artificial neural network (ANN) procedures. The ALM model building method involved Forward Stepwise using the F Statistic criterion. As regards ANN, multilayer perceptron (MLP) with back-propagation network was used. The ANN network was trained with 90% of the data set while 10% were dedicated to testing for model validation. RR and PR were the two parameters of utmost importance in the prediction of HSI. However, the fractional importance of RR was higher than that of PR in both ALM (0.947 versus 0.053) and ANN (0.677 versus 0.274) models. The two models also predicted HSI effectively with high degree of accuracy [r = 0.980, R² = 0.961, adjusted R² = 0.961, and RMSE = 0.05168 (ALM); r = 0.983, R² = 0.966; adjusted R² = 0.966, and RMSE = 0.04806 (ANN)]. The present information may be exploited in the development of a heat stress chart based largely on RR. This may aid detection of thermal discomfort in a poultry house under tropical and subtropical conditions.

Pattern of presentation of gastroesophageal reflux disease among patients with dyspepsia in Kano, Nigeria

BACKGROUND

Dyspepsia is a symptom complex rather than a specific disease entity. It can be caused by both organic and functional gastrointestinal (GI) disorders. Gastroesophageal reflux disease (GORD) though a common digestive disorder worldwide is scarcely reported in Nigeria. The aim of this study is to determine the pattern of presentation of GORD among patients with dyspepsia.

METHODS

One hundred and seventy dyspeptic patients were recruited consecutively as they were referred to the Gastroenterology Unit of Aminu Kano Teaching Hospital for upper GI endoscopy. A prepared questionnaire on relevant demographic and clinical history relating to GORD was administered. Upper GI endoscopy was then performed on each patient.

RESULTS

The prevalence of GORD was 24.1%, with a M:F ratio of 1:1.1. Endoscopy-positive variant accounted for 16 cases (9.4%), while endoscopy-negative variant accounted for 25 cases (14.7%), with of the total GORD patients, 26(63.4%) were males while 15(36.6%) were females. Los Angeles Grade A (37.5%) was the predominant endoscopic esophageal mucosal injury found in 6 cases. Barrett's esophagus and esophageal adenocarcinoma accounted 4.9% each and were considered to be rare. Extra-esophageal manifestations were also rare.

CONCLUSIONS

Endoscopy-negative variant still remains the predominant endoscopic finding in GORD patients.

Hemodialysis among pregnancy related acute kidney injury patients: A single center experience in North-Western Nigeria

Pregnancy related acute kidney injury (PRAKI) patients that underwent hemodialysis (HD) between May 2007 and April 2015 were studied with specific reference to clinical features, laboratory values, duration of pregnancy at the diagnosis of acute kidney injury and outcome. It involved 38 patients aged between 15 and 30 years. The main clinical features were fever, edema and oliguria. The leading etiological factors included ante/postpartum hemorrhage, septic abortion, and toxemia of pregnancy. The majority of cases occurred during the third trimester. PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. HD improved patient survival in our study.

Dielectric Behavior of OPEFB Reinforced Polycaprolactone Composites at X-Band Frequency

Short fibres are often used as reinforcing materials with thermoplastic polymers to improve the dielectric properties of the composites. In this work, the effects of oil palm empty fruit bunch (OPEFB)-fibre loading on polycaprolactone (PCL) polymer were extensively studied. The synthesis of OPEFB-PCL composites were prepared via melt blend method. Theoretical and experimental analysis of electromagnetic (EMI) propagation, absorption and shielding effectiveness (SE) properties of the composite were also studied. The magnitudes of S-parameters for OPEFB fiber-reinforced PCL composites with different percentages of filler were measured by a rectangular waveguide connected with a microwave vector network analyzer (VNA) at (8 – 12) GHz frequency. Whilst the dielectric properties were studied using an open ended coaxial probe. The morphological characterization of the OPEFB-PCL composite was carried out using X-ray diffraction and scanning electron microscopy (SEM). This work showed that XRD profile patterns slightly changed duo to the filler loading increment which result a reduction in both dielectric constant and loss factor. However, the relative permittivity of pure oil palm fibre and PCL was measured as (1.8-j*0.08) and (2.929-j*0.3242) respectively. In addition, the composition of 12.5 wt% filler gave the highest dielectric constant and loss factor values. However, the reflection loss increases to filler content increments at the maximum frequency of 12 GHz. The excellent behavior of these polymer composites makes them superior nominees for microwave low absorption materials.

The Effect of ZnO Nanoparticle Filler on the Attenuation of ZnO/PCL Nanocomposites Using Microstrip Line at Microwave Frequency

This paper describes attenuation measurement using the modified micrsotrip line technique from new microwave substrate material. The magnitudes of the transmission coefficient (S21) from the microstrip measurement were used to determine the attenuation of the ZnO/PCL nanocomposites substrate with respect to different percentages of ZnO nanoparticles filler. Result from the measurement showed amongst others that as the filler content increases, the attenuation increases. The highest magnitude for attenuation was calculated for the 70% ZnO nano filler with a value of 14.92 dB and the least attenuation was calculated for the 25% ZnO nano filler, which value gave 6.72 dB which is very good for shielding applications. Transmission electron microscope (TEM) was used to analyse the average particle size of the ZnO powder used as filler in the study. The analysis showed that the average partcile size was 52.7 nm.

Hemodialysis performance and outcomes among end stage renal disease patients from Sokoto, North-Western Nigeria

The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated.

Feasibility tests for treating shampoo and hair colorant wastewaters using anaerobic processes

Wastes from the personal care product (PCP) industry are often high in biodegradable carbon, which makes them amenable to aerobic biological treatment, although process costs are usually high due to aeration inefficiencies, high electricity demand and production of large amounts of sludge. As such, anaerobic treatment technologies are being considered to lower net energy costs by reducing air use and increasing methane production. To assess the amenability of PCP wastes to anaerobic treatment, methane yields and rates were quantified in different anaerobic reactors treating typical PCP wastes, including wastes from shampoo and hair colorant products. Overall, shampoo wastes were more amenable to methanogenesis with almost double the methane yields compared with colour wastes. To assess relevant microbial guilds, qPCR was performed on reactor biomass samples. Methanosaetaceae abundances were always significantly higher than Methanosarcinaceae and Methanomicrobiales abundances (P < 0.05), and did not differ significantly between waste types. Although colour wastes were less amenable to anaerobic treatment than shampoo wastes, differences cannot be explained by relative microbial abundances and probably result from the presence of inhibiting compounds in hair colorants (e.g., oxidants) at higher levels. Results showed that anaerobic technologies have great potential for treating PCP wastes, but additional work is needed to establish the basis of elevated methane yields and inhibition, especially when colorant wastes are present.

Analisis factorial de componentes principales con rotacion varimax de características zootécnicas de la oveja Uda

Se realizó un estudio para determinar la interdependencia entre los caracteres de conformación de 359 carneros Uda usando el analisis de componentes principales. Las medidas corporales fueron: alzada a la cruz, longitud corporal, perímetro torácico, alzada a la grupa, ancho y longitud de grupa, longitud de la cara, longitud de pata delantera y la anchura de la espalda. Los animales fueron agrupados por edades en: dientes de leche, 2 dientes, 4 dientes, 6 dientes, 8 dientes y dientes desgastados. El grupo de edad de los animales fue una fuente de variación significativa (p

Analisis discriminante del dimorfismo sexual de caracteres morfológicos de patos muscovy africanos

Se estudió el dimorfismo sexual en 221 patos, Muscovy Africanos, adultos, seleccionados al azar, explotados extensivamente en la región norte centro de Nigeria, empleando para ello medidas uni y multivariadas del tamaño corporal y proporciones del esqueleto. Los parámetros corporales investigados incluyeron: peso corporal, ocho medidas lineales corporales (circunferencia de la pechuga, BTC; circunferencia del muslo, THC; longitud del cuerpo, BDL; longitud del pico, BLL; longitud del cuello, NKL; longitud del pie, FTL; longitud total de la pata, TLL y longitud del ala, WNL) y cuatro índices morfológicos (masividad, solidez, largura de la pata e índice de condición). El análisis univariado mostró la dominancia del macho (p

Pitfalls in diagnosis of hepatitis B virus infection among adults Nigerians

OBJECTIVE

Hepatitis B virus infection is common in Nigerians and its diagnosis is necessary for effective treatment and eradication. This study is aimed at highlighting the serological factors jeopardizing the diagnosis and treatment of the infection among Nigerians adults.

PATIENTS AND METHODS

Three studies were carried out. The first study involved 56 Nigerian adults and it compared the assay of HBsAg by Haemagulation Method (HMA) with Enzyme linked immunoassay (ELISA). The second study was a comparison of Glaxo Welcome HB rapid test(GWHB) with ELISA in sero-assay of HBsAg and HBeAg among 25 Nigerian subjects while the third study was on the assay of the sera of HBsAg positive patients for HBeAg and anti-HBe in forty two Nigerian patients by ELISA.

RESULTS

The sero - prevalence rates of HBsAg were 41.8% and 61.8% by HM and ELISA respectively with false HBsAg sero-positives and sero-negatives by HM of 5.4% and 25.5% respectively. Similarly, there was sero-detection of HBsAg in 84% and 80% by ELISA and GWHB respectively in 25 Nigerian adults. In addition, 19% and 64% of the 42 patients with HBsAg sero-positivity were also positive for HBeAg and anti-HBe respectively, while 31% of the patients were both HBeAg and anti-HBe sero-negative.

CONCLUSION

Sero-diagnosis of HBsAg and other serological markers of infectivity in patients with HBV should be carried out by ELISA rather than HMA among adult Nigerians. Furthermore, high infectivity of the virus abounds among Nigerian with HBV infection.

Anatomical subsite and diagnostic implications of colorectal cancer in zaria (Guinea savannah)-1981-2005

OBJECTIVE

To study the clinicopathological characteristics of Colorectal Cancer (CRC) in the Guinea Savannah region; identify sub site; ascertain any change in the anatomical sub-site between 1981-2005; relate tumour stage/differentiation, to age young =40 years and = 41years old patients Highlight option for diagnosis in the sub region.

SETTING

There were 262 patients consisting of 125 retrospective and 137 prospective cases seen in the premier tertiary health institution in Northern Nigeria.

RESULTS

The Male:Female ratio = 1.37:1, mean age 39.8 years, cluster age group 3rd-6th decade( 82.1%), patients = 40years constituted 48.2% . Main clinical features present for more than 6 months were bloody mucus discharge (83.5%), palpable rectal mass (67.9%), pain (67%), tenesmus (60.1%). Ignorance of the disease was rife amongst non-specialists, spiritualists and the patients. The left colon was eleven times more commonly affected than the right colon. The rectum was the commonest sub site (74.3%). In 2 out of every 3 patients, the tumour was digitally palpable per rectum. There was no shift in the distribution sub site in (1981-1990), and (1991-2005). 97.2% the tumours were adenocarcinoma. 68.9% patients had advanced disease Duke C or D. 3 out of every 4 patients (= 40 years age group) had advanced disease. Histological prognostic grade of tumour was inversely related to =40 years age group. Routine digital rectal examination as an investigative armamentarium,and public awareness may reduce the prevalence of advanced CRC in the low resource subregion,we advocate their use.

Relationship between epistaxis and hypertension: a study of patients seen in the emergency units of two tertiary health institutions in Nigeria

BACKGROUND

Both epistaxis and hypertension are common in the general population.

OBJECTIVE

This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension.

METHODS

Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 +/- 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done. Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxis were selected by simple random sampling as controls.

RESULTS

Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 +/- 40.7 mmHg versus 123.2 +/- 16.3 mmHg systolic, P=0.001), and (91.3 +/- 24.8 mmHg versus 78.2 +/- 12.8 mmHg diastolic, P=0.001), and higher proportions of patients with previous history of hypertension (32.3% versus 7.9%; p<0.001) and family history of hypertension (12.9% versus 2.6%; p<0.02). The proportion of subjects with blood pressure elevation at presentation that remained sustained was significantly higher among the epistaxics than the nonepistaxics (87.5% versus 47.6%, chi2=8.1, P=0.005). The epistaxics had significantly higher prevalence of hypertension than the non-epistaxics (45.2% versus 13.2%, chi2=17.5, p=0.001). Univariate analysis demonstrated association between epistaxis and hypertension (OR=5.4, 95% CI=2.4-12.5, P=0.001), and between epistaxis and age (OR=0.9, 95% CI=1.3-12.5, P=0.02). On multivariate analysis using logistic regression the association between epistaxis and hypertension persisted, after adjusting for age, sex, season and causes of epistaxis (OR=5.6, 95% CI=1.7-15.6, P=0.01).

CONCLUSIONS

Our findings support an association between epistaxis and hypertension in the study population.

Risk of hepatitis B virus in the slaughter house

The study involved 180 Nigerian butchers and 180 traders (controls) selected by multistage stratified sampling who had their sera assayed for HBsAg (hepatitis B surface antigen) by enzyme-linked immunosorbent assay method. The butchers and the controls had an HBsAg sero-prevalence rate of 9.4% and 3.3%, respectively. Various risky practices were more common among the butchers but their hepatitis B antigenaemia was not related to the duration of their occupational exposure. The study shows that the butchers constitute a high risk occupation for hepatitis B viral infection.

Nigerian butchers and hepatitis B virus infection

Various target groups have been identified in Nigeria for studying the prevalence of hepatitis B virus infection; however there is no information on its prevalence among workers in slaughter houses. This study determined the seroprevalence of hepatitis B virus infection in Nigerian butchers at Ibadan, and comprised 360 healthy Nigerian adult subjects (180 butchers, 180 traders as controls) selected by multistage stratified sampling. A questionnaire was used to collect relevant information and included points about risk behaviour. ELISA was used to detect the hepatitis B surface antigen in the serum; the seroprevalence rate in butchers and controls was 9.4% and 3.3%, respectively (p<0.05). Risk behaviour was seen more commonly in butchers than in controls. The presence of hepatitis B surface antigen in the serum was not related to the duration of occupational exposure or the number of partners. In summary, butchers comprise a high-risk occupational group for exposure to hepatitis B virus infection. We conclude that routine screening for parenterally acquired infections in this group is thus necessary in order to identify those who will require treatment and immunisation, especially against hepatitis B virus infection.

Cutaneonephrobronchial fistula: an unusual presentation of an inadequately treated perinephric abscess

We report a case of cutaneonephrobronchial fistula secondary to an inadequately treated perinephric abscess associated with a staghorn calculus. The patient, a 72-year-old lady, was initially treated for a superficial flank abscess by incision and drainage. She returned 4 months later with a persistent discharging flank sinus, at which time the above complex pathology was diagnosed. We review similar cases in the literature and discuss pathophysiology and current management of perinephric abscesses.

The most appropriate site for endoscopic biopsy for the detection of H. pylori among Nigerians in Ibadan

BACKGROUND

Helicobacter pylori is a significant aetiological factor for acid peptic diseases and gastric cancer. Detection of the organism in gastric mucosal biopsies is important, hence the need to ascertain the optimal site for biopsy that will facilitate identification of the organism.

STUDY DESIGN

The study was carried out by obtaining directed gastric and duodenal endoscopic biopsies from twenty-five adult Nigerian patients clinically diagnosed to have gastroduodenitis at the University College Hospital, Ibadan, Nigeria. Biopsies were obtained from the gastric body, pyloric antrum, first and second parts of the duodenum at endoscopy. The biopsy specimens were tested for H. pylori by Campylobacter-like organism (CLO) test and histology.

RESULTS

Positive results for H. pylori by CLO test were detected in 67% each for the biopsies taken from the gastric antrum and incisura angularis; and 28% and 17% for those taken from first and second parts of the duodenum respectively. There was no benefit in taking additional biopsy from incisura angularis to that from the antrum. Helicobacter pylori was better detected in the mucosa of the antrum (72%) than that of the duodenum (28%), p < 0.05. The organism was detected in 28% by histological examination of the tissue specimen of the patients compared to 72% by CLO test, p < 0.05.

CONCLUSION

The study shows that the detection of H. pylori by invasive technique is better obtained by taking biopsy at the gastric antrum in Nigerian patients with gastroduodenitis. Furthermore, the CLO test yields more positive results than histological evaluation in the detection of the infection.

Clinicoradiologic and sonographic patterns of metastasis in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is usually diagnosed at an advanced stage, when little remedy could be offered. There is a need for relatively affordable, available and non-invasive tests for diagnosis, staging and detection of metastasis among individuals at risk. A clinical, chest radiographic (CXR) and abdominal ultrasonographic examination was carried out to detect and evaluate the pattern of metastasis among 53 untreated patients. One patient had clinical paraparesis with no outward evidence of metastasis. CXR revealed lung metastasis in 11 (20.8%), with multifocal deposits and bilateral involvement in 10 (18.8%), and unilateral single deposit in one. Two (3.8%) patients had perihilar lymphadenopathy and consolidation, respectively, while 18 (34%) patients had elevated right hemidiaphragm and four 17.5%) had pleural effusion. One had right basal pneumonitis, multiple cavitatory lesions in the lung fields and soft-tissue wasting. No abnormality was seen in 17 (32.1%) cases. Abdominal ultrasonograph showed probe tenderness in 22 (41.5%), hepatomegaly in 49 (92.5%), with 33 (62.3%) of these having nodularities of varying sizes. The spleen was enlarged in 10 (18.9%) cases, with four (7.5%) showing irregular outline. There were eight (15.1%) cases with para-aortic lymphadenopathy. Portal hepatic lymphadenopathy was demonstrated in two (3.8%) cases, while pleural effusion was detected in seven (13.2%). Metastasis is common in HCC at presentation, the lung is the commonest site of spread. Clinically visible metastasis appears uncommon in HCC.

Spontaneous liver rupture in pre-eclampsia

Spontaneous liver rupture is a rare complication of pre-eclampsia. A booked, 30-year old woman with pre-eclampsia and twin gestation developed severe abdominal pains 10 hours after a supervised, vaginal delivery. On examination she was in hypovolemic shock with abdominal distension from hemoperitoneum. Uterine rupture was suspected and she had a laparotomy after resuscitation. But at surgery the uterus was intact and instead liver rupture was found which was managed by omental packing after evacuating the clots. Postoperatively, the patient developed acute renal failure that responded well to treatment. The mother and her babies were discharged in good health after 15 days of multidisciplinary management.

Quality of life among primary liver cell carcinoma patients in Ibadan, Nigeria

A descriptive prospective study was conducted to evaluate the quality of life of patients with primary liver cell carcinoma at the University College Hospital, Ibadan, Nigeria. Quality of life (QOL) was evaluated using a modified WHO QOL Field Trial version questionnaire of December 1996. The QOL parameters include body pains, energy and acceptability of bodily appearance among others. Thirty-four patients aged between 23-74 years with a mean age of 49.6 +/- 13.4 were assessed. There were 28 (82.4%) males and 6 (17.6% females) (M/F = 4.6:1). Only about thirty percent of the patients rated their quality of life as being good or very good, with 70% rating their quality of life as very poor, poor or neither poor nor good. Eighty five percent of the patients were dissatisfied with their health, with 44.1% describing their health as very dissatisfying and only less than 10% enjoying satisfactory health. Eighty two percent of the patients responded that physical pain prevented them from doing what they want to do from moderate to extreme extent. All responders believed they require medical treatment to function in their lives with 22 (64%) requiring it very much. Seventeen (50%) of the patients had not enough energy at all for their daily activities, while 21 (61.7%) found their bodily appearance unacceptable to them. Fourteen (41.2%) did not receive adequate information they required about their day-to-day life. We conclude that our patients with PLCC have a low QOL rating and measures such as pain relief, reduction of bodily disfigurement and information to patients need to be put in place in order to improve their QOL.

Dispersal, disease and life-history evolution

Discrete-time susceptible-infective-susceptible (S-I-S) disease transmission models can exhibit bistability (alternative stable equilibria) over a wide range of parameter values. We illustrate the richness generated by such 'simple' non-linear systems in the study of two patch epidemic models with disease-enhanced or disease-suppressed dispersal. Dispersal between patches can have a profound impact on local patch disease dynamics. In fact, dispersal between patches may give rise to bistability in parameter regimes without bistability in single patch models.

Catheter-free endoscopic laser ablation of the prostate using a 1-size prostatic stent

PURPOSE

Endoscopic laser ablation of the prostate is a safe alternative to transurethral prostatic resection. Recognized disadvantages include prolonged catheterization, postoperative discomfort and delayed symptomatic improvement. We assessed the role of a 1-size temporary prostatic stent in men undergoing endoscopic laser ablation of the prostate.

MATERIALS AND METHODS

A total of 55 men a mean of 73 years old with outflow obstruction, including 9 who presented in urinary retention, underwent endoscopic laser ablation of the prostate and temporary stenting. Urinary flow rate, residual urine volume, symptom score and prostate specific antigen were measured preoperatively, and 6 weeks (with the stent in situ), 3 months (after stent removal) and 12 months postoperatively. Duration of hospital stay and complications were also recorded.

RESULTS

Of the 55 men 37 (67%) voided immediately with the stent in situ, including 7 of the 9 in retention. At 6 weeks with the stent in place mean maximum urine flow was 17.3 ml. per second (preoperatively 8.7). Dysuria was reported by 3 patients. Stent related complications were rare. One stent migrated early, resulting in urinary retention, while 2 that migrated late were asymptomatic. No patient had acute urinary retention after stent removal. Maximum urinary flow rate measured at 6 weeks with the stent in situ was similar to that 1 year after endoscopic laser ablation of the prostate.

CONCLUSIONS

The use of a 1-size, inexpensive plastic prostatic stent enabled catheter-free endoscopic laser ablation of the prostate in 67% of our patients. Early improvements in the urinary flow rate and a lower incidence of dysuria were additional benefits. The result of endoscopic laser ablation of the prostate at 1 year was comparable to that of transurethral prostatic resection.