Train-the-trainers intervention for national capacity building in infection prevention and control for COVID-19 in Nigeria.

Background: The first case of COVID-19 in Nigeria was reported on February 27, 2020, and over time, spread across the country leading to many healthcare worker infections. The risk of transmission of COVID-19 within healthcare facilities makes it necessary to establish infection prevention and control measures. The World Health Organisation supported the Nigeria Centre for Disease Control to conduct a train-the-trainers workshop on infection prevention and control for key healthcare workers across Nigeria. Aim/Objectives: This study aims to describe the process and results of train-the-trainers as an intervention for national capacity building in infection prevention and control for COVID-19 among healthcare workers in Nigeria. Methods: Eight-hour sessions were held over three days with face-to-face instruction and practical hands-on experience in April 2020. A total of 61 healthcare workers participated across the six geographic zones of Nigeria: North Central, North East, North West, South West, South East, and South South. The training included slide presentations, case-based scenarios, and practical hands-on sessions with plenary discussions. Pre- and post-test assessments were used to evaluate knowledge of COVID-19, triage, and infection prevention and control among healthcare workers. Finding/Results: 69 % (42) of the participants were male 31 % (19) were female, and the majority (67 %) were medical doctors. Others attending were nurses or health administrators. Of the 70 % (26) of the states with existing infection prevention and control structures within the COVID emergency response, only 40 % were functional. The average percentage of pre-test and post-test scores were 60.8 ± 13.4 and 67.8 ± 9 0.3 respectively, showing a statistically significant difference (p > 0.001) in trainee knowledge. Additionally, 70 % of participants evaluated the training workshop as "satisfactory" or higher in training format, relevance for daily clinical work, active participation, learning new concepts, and logistics. Conclusion: Nationwide infection prevention and control training is feasible during a national health crisis. Infection prevention and control is cardinal in the containment of epidemic-prone diseases like COVID-19 and is invaluable in the prevention of healthcare-associated infections in healthcare settings.

Immunohistochemical Patterns of Pituitary Adenomas in Southeastern Nigeria, a 10-year Histopathologic Review.

Introduction: Pituitary adenomas [PAs] constitute the third most common primary intracranial tumours, with a wide prevalence rate of 1% to 40%. Histologic (H & E) classification into acidophilic, basophilic and chromophobic adenomas have little clinical relevance but WHO recommended immunohistochemical subclassification has both therapeutic and prognostic significance. This immunohistochemical subclassification has not been done in our environment, making it imperative for us to evaluate the patterns in our environment.Aim: To determine the immunohistochemical patterns of PAs in Southeastern Nigeria.Materials and Methods: This was a 10-year retrospective review of all PA biopsies received at University of Nigeria Teaching Hospital Enugu, Memphys Hospital for Neurosurgery Enugu and Grace Pathology Consults Enugu, Nigeria. The age, sex, histologic, immunohistochemical subtypes and biopsy size of all diagnosed PAs were analyzed using Statistical Package for Social Sciences (SPSS) version 20 (New York: IBM Inc.) and the results were expressed in descriptive statistics.Results: One hundred cases of PAs were identified in this study constituting 19.6% of all primary intracranial tumors received at our study centers during the period under review. There were 45 (45.0%) females and 55 (55.0%) males giving a female to male ratio of 1:1.2, and a mean age of 45.3 years. The commonest histologic type was acidophilic adenoma (49.0%), followed by basophilic (40.0%) and chromophobic (11.0%) adenomas. Null cell adenomas were the most common immunohistochemical subtype (44.0%), followed by PRL-secreting adenomas (27.0%). Others were Luteinizing hormone (LH) - 13 (13.0%), follicle stimulating hormone (FSH) - 7 (7.0%), growth hormone (GH) - 3(3.0%), TSH - 2(2.0%) and ACTH - 1(1.0%) adenomas.Conclusion: PAs predominate amongst males, occurring mostly in the middle age groups in Southeastern Nigeria. Null cell adenoma is the commonest immunohistochemical subtype followed by PRL-secreting adenomas. Routine immunohistochemical characterization is required for accurate diagnosis and optimal patient care.

Etiologic dilemma and challenges of management of nodular vasculitis in tertiary health-care facility: A case report.

Nodular vasculitis is a rare inflammatory disease of the skin and subcutaneous fat tissue, characterized by crops of small, tender, erythematous nodules on the legs, mostly on the calves and shins. We present a 17-year-old adolescent female who presented with a six-month history of cough; recurrent fever and bilateral lower limb multiple ulcerated nodules of 1-month duration. Clinical examination revealed generalized lymphadenopathy with bilateral pitting leg edema which had multiple nodules and discoid ulcers extending from the groin to the ankles and discharging purulent fluid. Tests for human immunodeficiency virus and tuberculosis were negative. Histology of nodule biopsy revealed extensive caseous and coagulative fat necrosis, granulomatous inflammation with epitheloid macrophages and multinucleated giant cells surrounding the necrosis, and lymphoid infiltration of vessel walls with fibrous thickening of the intima, typical of Whitfield-type erythema induratum. There was initial but very transient response to antibiotic treatment, with further deterioration and eventual death from overwhelming sepsis.

Predictors of knowledge, attitudes and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria.

Background: Family planning deficiencies are responsible for high maternal, newborn, and child mortality in Nigeria, and more than half of all death among adult female is linked to maternal death. Aim: To ascertain the predictors of good knowledge, positive attitudes, and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria. Subjects and Methods: A cross-sectional research was carried out among public secondary school teachers aged between 18 and 60 years in Enugu East Senatorial District, Nigeria, using probability proportional to size sampling and systematic random sampling from a selection of 1,000 participants. Factors considered included sources of information on family planning, partner involvement, history of family planning methods, and healthcare facilities. Bivariate and multivariable logistic regression analysis was employed to establish the relationship. An odds ratio of 95% confidence interval (CI) was estimated to ascertain the level of significance. Result: A majority (65.9%) of respondents had a good knowledge of family planning, more than half had positive attitudes (52.7%), and most of them had ever practice family planning (55.0%). Television (AOR = 2.17; 95% CI 1.54-3.06) and social media (AOR = 1.89; 95% CI 1.29-2.78) were effective sources of information to establish significant predictors of good knowledge on family planning. Healthcare (AOR = 0.68; 95% CI 0.51-0.92) and partner discussion (AOR = 3.19; 95% CI 1.94-5.27) were also significant determinants of positive attitudes towards family planning. Cost of obtaining family planning methods (AOR = 0.003; 95% CI 0.001-0.013) and proximity of family planning facilities (AOR = 0.04; 95% CI 0.02-0.10) were notable predictors of ever practice family planning. Conclusion: The level of knowledge, attitudes, and ever practiced family planning among teachers are moderate and a significant number of predictors were identified. Effective awareness is recommended and making use of television as a channel to increase levels of knowledge will hopefully encourage utilization of family planning among teachers.

Comparative Analysis of Umbilical Nodules in Male and Female Patients: A 20-Year Retrospective Study.

BACKGROUND AND AIMS: The umbilicus is known to receive metastatic malignancy from diverse visceral organs. Accurate and correct diagnosis of umbilical lesions is imperative since metastatic malignancy signifies a serious underlying situation with dire prognosis. Identification of demographic features that can contribute to diagnostic resolution of umbilical lesions is desirable. We analyzed umbilical biopsies received over a 20-year period to determine any gender distinctive attributes of umbilical nodules. MATERIALS AND METHOD: All umbilical biopsies received in our department from 1st January 2000 to 31st December 2019 were identified and analyzed. Data acquired included patient's gender, age, date of biopsy, type of biopsy and histopathological diagnoses and these were analyzed using computer software. RESULTS: There were 67 umbilical biopsies from 22 males and 45 females giving a male: female ratio of 1:2. The difference between the mean age (SD) of male patients [47.8 years (19.4 years)] and that of the females [42.8 years (13.9 years)] was not statistically significant (p=0.28). Twenty-five of the 67 umbilical lesions were benign while 42 were malignant. About 90.9% of biopsies in males were malignant and 9.1% benign while 48.9% of biopsies in females were malignant and 51.1% benign. The odds of malignant umbilical biopsy in males compared to females is 10.5 [OR=10.5; 95% CI=2.2-50.1)]. CONCLUSION: Umbilical biopsies were relatively infrequent in our practice and were more common in females than males. Umbilical lesions presented by males are mostly malignant. Overall, 78% of all umbilical lesions in females were of gynecological derivation.

Design and implementation of a crossflow turbine for Pico hydropower electricity generation.

This study covered the design, implementation and performance evaluation of a crossflow turbine at various nozzle positions. The chosen blade material was analyzed using ANSYS for stress and deformation degree under the impact of hydraulic jets to ascertain its suitability while in operation. The shaft was analyzed under static and dynamic conditions using ANSYS in order to ensure a non-plastic deformation of the shaft at both conditions. The outcome of this analysis was employed in the harmonic response analysis of the runner shaft. Convergent tests were done for both the blade and runner shaft analysis. An experiment was designed for the evaluation of the crossflow turbine performance using optimal (custom) design tool of response surface methodology and 69 simulations/runs were obtained. The factors considered in the experimental design are: nozzle distance from the shaft, nozzle height and attack angle. The crossflow turbine was constructed using computed design values for all the machine's parts. The runner blades were positioned specifically at 28° outer blade angle and 90° inner blade angle. The turbine was tested under a water head and flow rate of 6.4m and 0.0042 m 3 / s respectively. The shaft power and efficiency were evaluated using their respective formula. The responses were optimized in order to get the optimum position of the nozzle that would give the best performance of the responses using the two factor interaction (2F1) mathematical models in coded factors, developed for each of the response. The results obtained, proved that low carbon steel material was suitable for the turbine blading and the shaft is safe at both static and dynamic conditions since the induced stresses and deformations never exceeded the permissible range. Also, each of these considered nozzle positions had a significant effect on the responses with the nozzle height and attack angle having a combined effect on the performance of the turbine. The best turbine performance was obtained at lower angle of attack, nozzle distance very close to the runner shaft and at a nozzle height that will actualize greater energy impartation to the upper and lower blade profiles. The developed mathematical models for each response has higher correlation value, suggesting that the models are suitable for predicting the responses at the considered factor levels. An optimal nozzle distance, height and attack angle of 102mm, 413mm and 5 ° respectively, were obtained. At this nozzle position, the alternator gave an output of 35watts and 6V. When two voltage transformers were employed, it gave 200Volts AC. The turbine can be commercialized on large scale for greater output power using the determined optimal nozzle positions.

Prevalence and predictors of postpartum depression among postnatal women in Lagos, Nigeria.

BACKGROUND: Globally, postpartum depression is one of the most common but often unrecognized complications of childbirth, yearly affecting about 10-15% of postnatal women. This study aimed to determine the prevalence of postpartum depression and its predictors among postnatal women in Lagos. METHODS: A descriptive cross-sectional study was conducted among 250 mothers in Eti-Osa Local Government Area of Lagos State, Nigeria, attending six Primary Health Care centers for infant immunization at six weeks post-delivery. Data was collected using a pretested semi-structured interviewer administered questionnaire which included the Edinburgh Postnatal Depression Scale. Analysis was carried out using SPSS version 23TM. Chi-square and logistic regression analyses were used to determine associations and predictive relationships between various factors and the presence of postpartum depression. The level of significance was set at <0.05. RESULTS: The prevalence of postpartum depression was 35.6%. Multiparity, delivery by cesarean section, mother being unwell after delivery, and not exclusively breastfeeding the baby were the factors linked with postpartum depression. Following multiple logistic regression, having postpartum blues (p=0.000; OR=32.77; 95%CI=7.23-148.58)., not getting help with caring for the baby (p=0.008; OR=2.64; 95%CI=1.29-5.42), experiencing intimate partner violence (p=0.000; OR=5.2; 95%CI=2.23-11.91) and having an unsupportive partner (p=0.018; OR=2.6; 95%CI=1.17-5.78) were identified as predictors of postpartum depression. CONCLUSION: This study revealed a high prevalence of postpartum depression, identifying both the obstetric and psychosocial predictors. Social support for women both in the pre- and postnatal periods and routine screening of women for postpartum depression should be encouraged for early detection and immediate intervention.

HIV/AIDS-Related Knowledge, Attitudes and Uptake of HIV Testing Services:A Comparative Study of Male and Female Secondary School Students in Lagos, Nigeria.

BACKGROUND: Knowledge of HIV/AIDS and use of HIV Testing Services in Nigeria is still far from optimal. Good HIV/AIDS-related knowledge and attitudes are important in prevention. The aim of this study was to assess and compare HIV/AIDS knowledge, attitudes and the uptake of HIV Testing Services between male and female senior secondary school students in Lagos, Nigeria. METHODS: Using multistage sampling, 543 (50.3% male, 49.7 % female) participants were selected in a comparative cross-sectional study carried out in six senior secondary schools in Alimosho LGA, Lagos. Data was collected using a pre-tested, self-administered questionnaire and analyzed using SPSS- 20, p<0.05 was considered significant. RESULTS: Participants' level of knowledge of HIV/AIDS was good (86.4% male, 86.3% female), the difference was not statistically significant. The main source of HIV/AIDS information was their teachers (male - 53.6%, female - 49.3%). Attitudes were positive (99.3% males, 98.1% females). However, the uptake of HIV testing was low (27.8% male, 24.1% female). Only 41.8% of males and 34.1% of females knew where HIV Testing Services were offered. The uptake of HIV testing showed a significant association, for the males, with family structure (p=0.034), confiding in their fathers (p=0.039) and religion (p=0.044), and for the females, mothers' level of education (p=0.036), number of siblings (p=0.044) and alcohol use (p=0.006). CONCLUSION: In both groups, knowledge and attitude were optimal, however. the uptake of HIV testing was low due to poor access. Teaching about HIV/AIDS in schools should be sustained, but to improve the use of HIV Testing Services, stronger families are encouraged, though providing more HIV testing centers, especially Youth Friendly Centers should be considered.

Health Insurance Knowledge, Attitude and the Uptake of Community-Based Health Insurance Scheme among Residents of a Suburb in Lagos, Nigeria.

BACKGROUND: Out of pocket payment for health services in the midst of financial hardship is a major contributor to poor access to healthcare in Nigeria with the resultant poor health indices. Towards the goal of Universal Health Coverage, Community Based Health Insurance (CBHI) was introduced in addition to the National Health Insurance Scheme but with minimal impact and utilization. OBJECTIVE: The objective of this study was to assess health insurance-related knowledge and attitudes and to examine the uptake of CBHI. METHODS: This was a descriptive cross-sectional study. A multi-stage sampling method was used to select 419 respondents from the Ajeromi-Ifelodun community. A semi-structured interviewer-administered questionnaire was used to collect data for the study. Data analysis was done using Microsoft Excel and Epi-Info 7.1. RESULTS: Most of the respondents (80.2%) had not heard of Community-Based Health Insurance and only about 9% of respondents had good knowledge about it. However, most (62.5%) of the respondents had a positive attitude towards health insurance generally. Only 4.5% of the respondents were enrolled in the CBHI scheme and had paid their premium up to date. There was a significant association between the respondents' knowledge and their uptake of the scheme (<0.001), and also between their attitudes and uptake (p = 0.002). CONCLUSION: This study suggests that for CBHI to be successful, certain strategies must be implemented towards increasing awareness and knowledge about CBHI. This will in turn increase the uptake of the scheme, a necessary requirement for achieving the goal of Universal Health Coverage.

Health-Related Quality of Life of the Elderly in Institutional Care and Non-Institutional Care in Southwestern Nigeria: A Comparative Study.

BACKGROUND: The world population is rapidly ageing and people aged 60 years and above are growing faster than any other age group. In Africa, the most rapid growth of older persons is expected in Western and Northern Africa. STUDY DESIGN: This was a comparative cross-sectional study of a total of 360 respondents. A multi-stage sampling method was used in selecting 240 respondents in the non-institutional group while all the respondents (120) in the institutional group were included in the study. The data was collected using a pre-tested, semi-structured, interviewer administered quality of life questionnaire (SF-36). Data analysis was done using SPSS version 17. RESULTS: The respondents in the institutional group were older with a mean age of 78.7±8.8 years as compared to 70.1±8.2 years in the non-institutional group. The mean Health-Related Quality of Life (HRQOL) score was higher (64.5±15.6) in the non-institutional group than in the institutional group (52.6±15.7) and this was statistically significant (p<0.001). After controlling for the effect of other variables, the respondents who belonged to the non-institutional group (OR=2.37, p=0.018); who were female (OR=2.00, p=0.019); engaged in work (OR=4.93, p=0.009) and had no co-morbid condition (OR=7.58, p<0.001) were significantly more likely to have good HRQOL. CONCLUSION: The non-institutional group had better HRQOL than the institutional group in all the domains except in the body pain domain. It is recommended that programs are tailored to the needs of the elderly in institutions and should be targeted towards improving their quality of life and well-being.

Tuberculous Lymphadenitis in South-Eastern Nigeria; A 15 Years Histopathologic Review (2000-2014).

BACKGROUND: The human immunodeficiency virus (HIV) pandemic has brought about a resurgence in tuberculosis (TB), especially in developing countries. Previous studies on TB lymphadenitis (TBLN) in South-Eastern Nigeria were done before the advent of the HIV pandemic making a review pertinent. AIM: To evaluate the role of TBLN as a cause of superficial lymphadenopathy in the post-HIV/acquired immune deficiency syndrome (AIDS) era of South-Eastern Nigeria. MATERIALS AND METHODS: This is a 15 years (2000-2014) retrospective review of all superficial lymph node biopsies (SLNBs) received at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria. RESULTS: One hundred and seventy-two cases of TBLN were identified in this study constituting 14.6% (172/1,180) of SLNBs received at our Hospital's Morbid Anatomy Department during the 15 years period under review. Twenty-eight cases of TBLN were clinically screened for HIV, 23 of which tested positive, representing 82.1% (23/28) of clinically screened cases. Acid fast bacilli demonstration was positive in 15.1% (26/172) of cases using Ziehl-Neelsen stain. 48.8% (84/172) of TBLN cases were males, and 51.2% (88/172) were females with most (22) cases received in 2012 and least (5) cases in 2000. Most TBLN occurred in the 21-25 years age group with a total of 21.5% (37/172) of cases and a male to female ratio of 1:1.5 The most common biopsy site for TBLN was the cervical group followed by the axillary and inguinal groups with 73.8% (127/172), 14% (24/172), and 4.7% (8/172) of cases, respectively. CONCLUSIONS: There is a remarkable decline in the prevalence of TB lymphadenitis in South-Eastern Nigeria indicating a change in trend from the pre- to the post-HIV/AIDS era with slightly more females now presenting with TBLN and most TB lymphadenitis patients now presenting with associated HIV/AIDS disease. There is an urgent need to provide modern diagnostic facilities in our medical laboratories.

Pharmacogenetics of pregnancy-induced changes in efavirenz pharmacokinetics.

Pregnancy-induced physiological changes alter many drugs' pharmacokinetics. We investigated pregnancy-induced changes in efavirenz pharmacokinetics in 25 pregnant and 19 different postpartum women stratified from 211 HIV-positive women in whom a preliminary pharmacogenetic study had been undertaken. Despite significant changes in CL/F during pregnancy (42.6% increase; P = 0.023), median (range) Cmin was 1,000 ng/mL (429-5,190) with no significant change in Cmax (P = 0.072). However, when stratified for CYP2B6 516G>T (rs3745274) genotype, efavirenz AUC0-24 , Cmax and Cmin were 50.6% (P = 0.0013), 17.2% (P = 0.14), and 61.6% (P = 0.0027) lower during pregnancy (n = 8) compared with postpartum (n = 6) in 516G homozygotes, with values of 25,900 ng.h/mL (21,700-32,600), 2,640 ng/mL (1,260-3,490), and 592 ng/mL (429-917), respectively, and CL/F was 100% higher (P = 0.0013). No changes were apparent in CYP2B6 516 heterozygotes (14 pregnant vs. 7 postpartum). The clinical implications of these findings warrant further investigation.

Incidence, pattern and management of ovarian cancer at a tertiary medical center in enugu, South East Nigeria.

BACKGROUND: The incidence of ovarian cancer is thought to be increasing in developing countries and little is known about the pattern and incidence of this disease in South-East Nigeria. AIMS: The objectives of the study were to determine the incidence, describe the pattern and management of ovarian cancer at a tertiary medical center in Enugu South East Nigeria. MATERIALS AND METHODS: This was a retrospective review of cases of histologically diagnosed primary ovarian cancer at the study center over 11 years. Cases of histologically diagnosed primary ovarian cancer were identified through the records of the study center cancer registry and confirmed from the records of the histopathology department. Case notes, admission and theatre records were used to obtain data relating to clinical management, mortality and incidence of primary ovarian cancer. Statistical analysis was dose using SPSS statistical software version 17.0 for windows. Descriptive and inferential statistics were applied to obtain rates, proportions and 95% confidence intervals for these estimates. RESULTS: There were 20,227 gynecological admissions during the study period (from January 2000 to December 2010) and 206 gynecological cancers. There were 54 cases of primary ovarian cancer giving an incidence rate of 1/405 gynecological admissions per year or 0.3% (95% confidential interval [CI] 0.23%, 0.38%) or 2.4% (54/206) per gynecological cancer per year. Epithelial ovarian cancer constituted 68% of cases of ovarian cancer (95% CI 54%, 82%): Sex cord and germ cell tumors constituted 16% each (95% CI 6%, 26%). Approximately 60% of women who had epithelial ovarian cancer were aged 50 years or below (95% CI 47%, 74%) and 72% of epithelial ovarian cancer occurred in multiparous women (95% CI 72.1%, 91.9%). Over 84% of ovarian cancer presented in stages 3 and 4 of the disease (95% CI 94%, 72%). The mainstay of management was surgery: Compliance with cis-platinum based adjuvant chemotherapy was poor. Case-specific mortality rate within 1 year of diagnosis was, at least, 70% (95% CI 64%, 84%). CONCLUSIONS: Primary ovarian cancer was uncommon and consisted mainly of epithelial cancer. Epithelial ovarian cancer occurred more in multiparous women and in women under 50 years in our center contrary to the known pattern of the disease.

Prevalence of dermatological lesions in hospitalized children at the University College Hospital, Ibadan, Nigeria.

OBJECTIVE: Skin disorders constitute a significant proportion of consultations in children's clinics; however, there is a paucity of data on the prevalence of dermatological lesions in hospitalized children in Nigeria. This study determines the prevalence of dermatological lesions in hospitalized children. MATERIALS AND METHODS: In this cross-sectional study, 402 children aged three months to twelve years admitted in the Pediatric wards of the University College Hospital, Ibadan, were enrolled over a six-month period. Examination of the skin and its appendages was done for each patient. Data on the socioeconomic status, hygiene, and health-related factors were also obtained using a structured questionnaire. RESULTS: Over 96% of the children had at least one identifiable skin lesion. The five leading skin lesions were post-inflammatory hyperpigmentation (49.5%), BCG scar (28.4%), Mongolian spots (27.1%), junctional melanocytic nevi (20.1%), and cafι-au-lait macules (18.4%). The leading infectious skin disease was pyoderma (13.4%), followed by tinea capitis (6.7%). Scarification marks (P=0.001), tinea capitis (P=0.014), plantar fissuring (P=0.001), and impetigo (P=0.016) were associated with low socioeconomic classes, while the presence of BCG scar (50.0%) was associated with the high socioeconomic class. CONCLUSIONS: This study shows that dermatologic lesions are common in hospitalized children. Identifying them will provide an opportunity for pediatricians to educate parents on the various causes as well as prevention of lesions.

Chronic thromboembolic pulmonary hypertension with pulmonary infarction occuring in a hypertensive.

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06, with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38 degrees C), in respiratory distress (RR-33 pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.

Chronic thromboembolic pulmonary hypertension with pulmonary infarction occuring in a hypertensive.

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06,with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38 degrees C), in respiratory distress (RR-33pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.

Effect of pineapple peel extract on total phospholipids and lipid peroxidation in brain tissues of rats.

OBJECTIVE: To investigate the ability of the methanolic extract of pineapple peel to attenuate alcohol-induced changes in total phospholipids and lipid peroxidation in brain tissues. METHODS: Oxidative stress was induced by oral administration of ethanol (20% w/v) at a dosage of 5 mL/kg bw in rats. After 28 days of treatment, the rats were fasted overnight and sacrificed by cervical dislocation. Brain tissues were assayed for total phospholipid (TP) content and malondialdehyde (MDA). RESULTS: Administration of alcohol significantly caused a reduction in TP content. Treatment with pineapple peel extract significantly increased the TP content. Significant high levels of MDA was observed in alcohol-fed rats, treatment with pineapple peel extract significantly reduced the MDA levels. CONCLUSIONS: Results obtained from this study indicates that pineapple peel extract protects against alcohol-induced changes in total phospholipids and lipid peroxidation in brain tissues.

Modulatory effect of pineapple peel extract on lipid peroxidation, catalase activity and hepatic biomarker levels in blood plasma of alcohol-induced oxidative stressed rats.

OBJECTIVE: To investigate the ability of the methanolic extract of pineapple peel to modulate alcohol-induced lipid peroxidation, changes in catalase activities and hepatic biochemical marker levels in blood plasma. METHODS: Oxidative stress was induced by oral administration of ethanol (20% w/v) at a dosage of 5 mL/kg bw in rats. After 28 days of treatment, the rats were fasted overnight and sacrificed by cervical dislocation. Blood was collected with a 2 mL syringe by cardiac puncture and was centrifuged at 3 000 rpm for 10 min. The plasma was analyzed to evaluate malondialdehyde (MDA), catalase activity, aspartate aminotransferase (AST), alkaline phosphatase (ALP) and alanine aminotransferase (ALT) concentrations. RESULTS: Administration of alcohol caused a drastic increase (87.74%) in MDA level compared with the control. Pineapple peel extract significantly reduced the MDA level by 60.16% at 2.5 mL/kg bw. Rats fed alcohol only had the highest catalase activity, treatment with pineapple peel extract at 2.5 mL/kg bw however, reduced the activity. Increased AST, ALP and ALT activities were observed in rats fed alcohol only respectively, treatment with pineapple peel extract drastically reduced their activities. CONCLUSIONS: The positive modulation of lipid peroxidation, catalase activities as well as hepatic biomarker levels of blood plasma by the methanolic extract of pineapple peels under alcohol-induced oxidative stress is an indication of its protective ability in the management of alcohol-induced toxicity.

Dilated alcoholic cardiomyopathy and incidental lymphoma occuring in a 56 year old man who was being managed for hypertensive heart disease in Enugu Nigeria--a rare finding.

We present a case of dilated alcoholic cardiomyopathy occurring in a 56-year-old Nigerian male. He admitted to taking alcoholic beverage, approximately 2-3 bottles of different brands of beer per day for about 30 years, but stopped three years ago on medical advice. He had a history of progressively worsening dyspnoea and encephalopathy, from decreasing ejection fraction. This resulted in a poor blood supply to the vital centers of the brain. Autopsy confirmed a dilated cardiomyopathy with an incidental fairly advanced B cell lymphoma involving the liver and spleen. The latter was thought to be a coincidental finding.

An analysis of disorders seen at the Paediatric Neurology Clinic, University College Hospital, Ibadan, Nigeria.

BACKGROUND: Paediatric neurological disorders constitute a major cause of disability in childhood. Children in the developing countries are disproportionately affected and in addition face the added burden of poverty, inadequate health facilities, stigmatisation and lack of facilities for rehabilitative care. OBJECTIVE: To describe the spectrum of neurological disorders seen among Nigerian children presenting at the paediatric neurology clinic of the University College Hospital, Ibadan, Nigeria. METHODS: All children presenting at the paediatric neurology clinic of the University College Hospital, Ibadan, Nigeria over a period of 20 months were prospectively studied. Diagnoses were made from detailed history, thorough physical examination, with particular emphasis on the central nervous system and appropriate investigations as indicated. RESULTS: There were a total of 644 cases during the study period, 369 males and 275 females, giving a male to female ratio of 1.3:1. There were 1353 consultations at the paediatric neurology clinic and these accounted for 21.0% of the total 6,442 consultations at the paediatric specialist clinics in the hospital. The most frequent paediatric neurological disorders were epilepsy (45.3%), cerebral palsy (36.0%), neuro-muscular disorders (4.5%) and mental retardation (4.5%). CONCLUSION: Paediatric neurological disorders constitute a major reason for paediatric specialist care in Ibadan, Nigeria. Preventable causes play a major role in the aetiology of the major paediatric neurological disorders seen in this part of the world.