Pre-exercise and acute movement-evoked pain trajectories during a 24-week outdoor walking program for knee osteoarthritis (WALK).

Objectives: Exploring (1) pre-exercise and acute movement-evoked pain (AMEP) during an outdoor walking program in individuals with knee osteoarthritis (OA); and (2) comparing baseline physical performance and AMEP flares initiated by walking between participants with either a higher or lower attendance rate. Methods: Individuals with knee OA were prescribed a 24-week walking program, including one unsupervised walk and two supervised walk classes per week. Participants self-reported knee pain on a numerical rating scale (NRS; 0-10) before and after each supervised class. Mixed-effects models were used to investigate trajectories over time for pre-exercise pain and AMEP change (post-minus pre-exercise pain; positive value indicates flare-up). Baseline physical performance (6 tests) and AMEP flares were compared between participants with higher (attending ≥70% of supervised classes) and lower attendance rates. Results: Of 24 participants commencing the program, 7 (29%) withdrew. Over 24 weeks, pre-exercise pain improved by 1.20 NRS (95% CI -1.41 to -0.99), with estimated largest per class improvements during the first 8 weeks (-0.05 (-0.06 to -0.03) and plateauing around 20-weeks. The AMEP was estimated to improve by 0.19 NRS (95% CI -0.38 to -0.004) over 24-weeks, with improvements plateauing around 12-weeks. Participants with lower attendance (n â€‹= â€‹11) scored poorer on all physical performance tests and experienced a slight increase in AMEP during the first two weeks of the program. Conclusions: Participants improved in pre-exercise pain and AMEP in the first 20 and 12 weeks, respectively. Despite supervision, physical performance and AMEP flares may have contributed to lower attendance. Trial registration number: 12618001097235.

Titanium mesh cranioplasty for cosmetically disfiguring cranio-facial tumours in a resource limited setting.

Background: The aesthetic reconstruction of disfiguring cranio-facial defects after tumour excision can be quite challenging to the neurosurgeon with limited resources. The choice of cranioplasty implant, intraoperative technicalities and the patients' postoperative appearance are critical considerations in management. There are a number of synthetic materials available for cranioplasty, however, the customised implants are not readily available in our practice setup. They are also mostly constructed and contoured after the bony defect has been created or require sophisticated software construction pre-operatively. Methods: Eight patients with cranio-facial tumour pathologies who presented to our neurosurgical service, and had titanium mesh cranioplasty for the correction of cosmetically disfiguring cranio-facial tumours. Results: There were 6 females, and 2 male patients respectively, with an age range between 28 and 74years. The histological diagnoses were meningioma, frontal squamous cell carcinoma, fibrous dysplasia, frontal mucocoele, cemeto-ossifying fibroma, osteoma, and naso-ethmoidal squamous cell carcinoma. The patient with naso-ethmoidal squamous cell carcinoma had post-operative subgaleal empyema which was amenable to incision and drainage procedure. The patient with a frontal cemento-ossifyng fibroma had a transient immediate post-operative mechanical ptosis, which resolved completely in 3months. All of the total eight patients (100%) had satisfactory cosmetic outlook at a minimum follow up period of 1month post-operatively (Numeric Rating Scale of at least 7/10). One of the patients required a revision surgery on account of implant displacement. Conclusion: Cranioplasty is a common reconstructive neurosurgical procedure. It is important to the neurosurgeon for its neuro-protective function, and in the restoration of intra-cranial CSF dynamics. However, the cosmetic outlook appears to be more important to patients in the absence of pain and/or neurological deficits. Titanium mesh reconstruction is commonly used globally, and is becoming the preferred choice in low resource settings.

Neurocritical Care in Nigeria.

Nigeria is the most populous country in Africa with an estimated 206 million inhabitants served by less than 300 neurologists and 131 neurosurgeons. Neurological conditions account for approximately 18% of all medical emergencies. Neurocritical care challenges in Nigeria are as complex as they are in other low-to-middle-income countries (LMICs). These include high burden of neurological diseases, poor pre-hospital care, delays in transfer, lack of neurocritical care equipment, and inadequate rehabilitative capacity. Neurocritical care units in Nigeria offer mostly limited multimodal monitoring due to out-of-pocket payment, and the success of repeat radiological imaging and blood work is low. Data gathering and outcome research in neurocritical conditions can help in clinical decision-making and enhance cost-effective clinical care. The concept of allocation requires that when medical resources are scarce, they must be efficiently utilized in the most judicious way so as to achieve the greatest possible benefit. A high degree of transparency is needed with regard to the principles, values and criteria employed to facilitate such triage decisions. Proper funding will help improve availability of equipment and drugs resulting in a higher quality of care and, subsequently, improvement in mortality. There is ample evidence that neurocritical care improves overall prognosis in neurocritically-ill patients. Neurocritical care units (NCCUs) are mostly unavailable in Nigeria, often resulting in poorer prognosis for patients. What is already known: Nigeria has an unacceptably huge deficit in the overall capacity for neurocritical care. The inadequacies affect a wide range of components - facilities, quantity and quality of personnel, and the unbearably high cost, among others. What this study adds: This article attempts to condense the challenges in one piece while highlighting previously obscure ones, with the aim of providing possible solutions to the lingering challenges in neurocritical care in Nigeria and, invariably, other LMICs. How this study might affect practice, policies or research: We envisage this article will stimulate the initial steps in a multipronged and data-driven approach to bridging the gap by government and relevant healthcare administrators.

Le Nigeria est le pays le plus peuplé d'Afrique avec une population estimée à 206 millions d'habitants et à peine moins de 300 neurologues et 131 neurochirurgiens au service de cette population. Les urgences neurologiques représentent environ 18 % de toutes les urgences médicales. Les défis posés par les soins neurocritiques au Nigeria sont aussi complexes que dans d'autres pays à revenu faible ou intermédiaire (PRFI). Il s'agit notamment du lourd fardeau des maladies neurologiques, de la médiocrité des soins préhospitaliers, des retards de transfert, du manque d'équipements de soins neurocritiques et d'une capacité de réadaptation réduite. Les unités de soins neurocritiques au Nigeria disposent d'une surveillance multimodale limitée en raison du paiement direct, et le succès de la répétition de l'imagerie radiologique et des analyses sanguines est faible. La collecte de données et la recherche sur les résultats dans les conditions neurocritiques peuvent aider à la prise de décision clinique et améliorer la rentabilité des soins cliniques. Selon le concept d'allocation, lorsque les ressources médicales sont rares, elles doivent être utilisées efficacement et de la manière la plus judicieuse possible afin d'obtenir le plus grand bénéfice possible. Un degré élevé de transparence est nécessaire en ce qui concerne les principes, les valeurs et les critères utilisés pour faciliter ces décisions de triage. Un financement adéquat permettra d'améliorer la disponibilité des équipements et des médicaments, ce qui se traduira par une meilleure qualité des soins et, par la suite, par une réduction de la mortalité. Il existe de nombreuses preuves que les soins neurocritiques améliorent le pronostic général des patients en état neurocritique. Les unités de soins neurocritiques (NCCU) sont pour la plupart indisponibles au Nigeria, ce qui entraîne un pronostic plus défavorable. Ce que l'on sait déjà : Le Nigeria souffre d'un déficit inacceptable en matière de capacité globale de soins neurocritiques. Les insuffisances touchent un large éventail d'éléments - installations, quantité et qualité du personnel, et coût insupportablement élevé, entre autres. Ce que cette étude apporte : Cet article tente de condenser les défis en un seul élément tout en mettant en lumière ceux qui étaient auparavant obscurs, dans le but de fournir des solutions possibles aux défis persistants des soins neurocritiques au Nigeria et invariablement dans les pays à faible revenu intermédiaire. Comment cette étude pourrait-elle affecter la pratique, les politiques ou la recherche ? Nous pensons que cet article stimulera les premières étapes d'une approche multidimensionnelle et axée sur les données pour combler le fossé par le gouvernement et les administrateurs de soins de santé concernés. Mots-clés: Soins Neurocritiques, Nigeria, Maladies neurologiques.

The prevalence of IGM antibodies to Zika virus in pregnant women in Northern Nigeria.

INTRODUCTION: Zika virus (ZIKV) infection during pregnancy can result in severe outcomes for both the pregnant woman and the developing fetus. The objective of this study was to investigate the prevalence of Zika virus infection among pregnant women who sought healthcare services at Ahmadu Bello University Teaching Hospital. MATERIALS AND METHODS: Serum samples were collected and analyzed using Enzyme Linked Immunoassay and RT-qPCR methods, while a structured questionnaire was used to gather relevant information about the participants. RESULTS: The results showed that 53 out of the 180 pregnant women tested positive for Anti-Zika IgM antibodies, which represents a 29.4% prevalence rate. Subsequent RT-qPCR analysis found that only 6 out of the 53 positive samples contained Zika virus RNA. Fever and headache were the most commonly reported symptoms related to the infection. CONCLUSION: These findings indicate a potential outbreak of Zika fever in Northern Nigeria emphasizing the importance for pregnant women to take precautions to avoid getting infected.

A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: walk.

OBJECTIVES: To determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes. METHOD: This was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures. RESULTS: Forty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking (n = 24) or usual care (n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: - 38.7 mm [95% CI - 47.1 to - 30.3] versus usual care group: 4.3 mm [- 4.9 to 13.4]). CONCLUSIONS: This study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial. TRIAL REGISTRATION NUMBER: 12618001097235. Key Points • This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible. • The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone. • The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies.

Feasibility of 'parkrun' for people with knee osteoarthritis: A mixed methods pilot study.

Objective: To investigate the feasibility of 'parkrun' for people with knee osteoarthritis (OA) and examine its potential to improve symptoms and increase physical activity. Design: This uncontrolled mixed methods pilot study enrolled people with knee OA not meeting physical activity guidelines. Participants were asked to walk in four consecutive parkrun events supervised by an exercise physiologist/physiotherapist. Feasibility was assessed by recruitment data (numbers screened and time to enrol 15 participants), adherence to the protocol, acceptability (measured by confidence, enjoyment, difficulty ratings and qualitative interviews), and safety (adverse events). Secondary measures were changes in knee pain, function, stiffness, and physical activity levels. Results: Participants (n â€‹= â€‹17) were enrolled over 11 months and recruitment was slower than anticipated. Fourteen participants attended all four parkruns and three of these participants shortened the 5 â€‹km course to ∼3 â€‹km. Across all four parkruns, 75% of participants reported high confidence that they could complete the upcoming parkrun and the majority (87%) enjoyed participating. Most participants rated parkrun either "slightly difficult" (38.5%) or "moderately difficult" (35%) and two mild adverse events were reported. Participants showed improvements in knee pain, function, stiffness, and physical activity levels. Conclusions: This pilot study demonstrates parkrun's feasibility, acceptability, safety and, its potential to improve knee OA symptoms and physical activity levels. Participating in parkrun was acceptable and enjoyable for some, but not all participants. The scalability, accessibility and wide appeal of parkrun supports the development of larger programs of research to evaluate the use of parkrun for people with knee OA.

Prevalence and Associated Risk Factors of Urinary Schistosomiasis among Primary School Pupils in the Jidawa and Zobiya Communities of Jigawa State, Nigeria.

Background: Urogenital schistosomiasis (UgS) is a parasitic disease caused by Schistosoma haematobium and can lead to chronic ill-health. Nigeria is endemic for schistosomiasis, but epidemiology of UgS has not been studied in most states. This study was conceived with the aim to contribute towards an accurate national picture of UgS in Nigeria. The prevalence of UgS and the associated risk factors were for the first time investigated among primary school pupils in Jidawa and Zobiya communities of the Dutse Local Government Area (LGAs) of Jigawa State, Nigeria. Method: Focus group discussions with teachers and parents were conducted. After obtaining written consent from parents, questionnaires were administered to pupils to obtain socio-demographic data and information on water contact activities. Urine samples (279) were collected and processed by the urine filtration technique to evaluate haematuria and the presence of S. haematobium eggs. Results: Prevalences of 65.7% (90/137) and 69.0% (98/142) were recorded in the Jidawa and Zobiya communities, respectively. In both communities, there was a significant association between gender and UgS: 63.3% of the infected pupils were males as compared to 36.7% females (χ2 = 5.42, p = 0.020). Grade 5 students had a significantly higher prevalence (χ2 = 17.919, p = 0.001) (80.0%) compared to those in grades 2, 3, 4, and 6 (63.8%, 66.7%, 61.5%, and 64.6%, respectively). Water contact activities showed that pupils involved in fishing, irrigation, and swimming were at greater risk of becoming infected in Jidawa and Zobiya, with odds ratios (risk factors) of 5.4 (0.994-28.862) and 4.1 (1.709-9.862), respectively (p = 0.05). Conclusion: Both the Jidawa and Zobiya communities of the Dutse LGAs of Jigawa State are hyperendemic for UgS. In collaboration with the State Ministry of Health, mass administration of praziquantel was carried out in the Jidawa and Zobiya communities after this study.

Nigerian resident doctors' work schedule: A national study.

Background and Aim: The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety. Subjects and Methods: A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05. Results: The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48-72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%). Conclusion: The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.

Tramadol-Induced Acute Seizures: A Report of Three Cases.

There is a rise in substance abuse in Nigeria and prescription drugs, particularly opioid analgesics, which are increasingly becoming a target of abuse. Abuse of the opiod tramadol has the potential to precipitate seizures. We present 3 cases of tramadol-induced seizures presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. The three patients were men, aged 22-40 years and abused other drugs including alcohol, cannabis and Rohypnol. This report illustrates the fact that tramadol abuse may be associated with acute seizures and it is reasonable to consider drug/opiod-induced seizure in every case of unexplained first episode of seizure in a young adult.

L'abus de substances psychoactives est en hausse au Nigeria et les médicaments sur ordonnance, en particulier les analgésiques opioïdes, qui deviennent de plus en plus une cible d'abus. L'abus de l'opioïde tramadol a le potentiel de précipiter des crises d'épilepsie. Nous présentons 3 cas de crises d'épilepsie induites par le tramadol se présentant à Complexe hospitalier universitaire Obafemi Awolowo, Ile-Ife. Les trois patients étaient des hommes, âgés de 22 à 40 ans et abusaient d'autres drogues dont l'alcool, le cannabis et le Rohypnol. Ce rapport illustre le fait que l'abus de tramadol peut être associé à des crises aiguës. associé à des crises d'épilepsie aiguës et il est raisonnable d'envisager une crise induite par le médicament ou par une période dans tous les cas de premier épisode de crise inexpliqué chez un jeune adulte. Mots clés: Tramadol, Toxicomanie, Crise d'épilepsie, Opioïde.

Aplasia Cutis Congenita: A Case Report.

Aplasia cutis congenita (ACC) is a rare developmental disorder that is not fully understood. It often occurs in isolation but can also be syndromic. Usually, there is an absence of the epidermis and dermis. It may be limited to the skin alone but may involve deeper structures. Research has identified a heterogeneous predisposition including genetic factors. Among patients with ACC, scalp involvement is common, however large scalp defects with the involvement of the skull is not common. We present a preterm neonate with a large scalp ACC with a wide skull defect.

L'aplasie cutanée congénitale (ACC) est un mal du développement rare qui n'est pas entièrement compris. Elle survient souvent de manière isolée mais peut également être syndromique. Habituellement, il y a une absence d'épiderme et de derme. Elle peut être limitée à la peau seule mais peut impliquer des structures plus profondes. La recherche a identifié une prédisposition hétérogène incluant des facteurs génétiques. Chez les patients atteints d'ACC, l'atteinte du cuir chevelu est fréquente, mais de grandes anomalies du cuir chevelu avec atteinte du crâne ne sont pas courantes. Nous présentons un nouveau-né prématuré avec un grand CCA du cuir chevelu avec un large défaut du crâne.

Skin Photosensitivity is Associated with 25-Hydroxyvitamin D and BMD but not Fractures Independent of Melanin Density in Older Caucasian Adults.

Whether skin photosensitivity modulates sun exposure behaviours, consequent vitamin D status and skeletal health outcomes independently of constitutive pigmentation have not been systematically investigated. 1072 community-dwelling adults aged 50-80 years had skin photosensitivity quantified by questionnaire and melanin density by spectrophotometry. Bone mineral density (BMD), falls risk and 25-hydroxyvitamin D (25OHD) were measured using DXA, short form physiological profile assessment and radioimmunoassay, respectively. Sun exposure and symptomatic fractures were assessed by questionnaire. Participants were followed up at 2.5 (n = 879), 5 (n = 767) and 10 (n = 571) years. Higher resistance to sunburn and greater ability to tan were associated with reduced sun protection behaviours (RR 0.87, p < 0.001 & RR 0.88, p < 0.001), higher lifetime discretionary sun exposure in summer (RR 1.05, p = 0.001 & RR 1.07, p = 0.001) and winter (RR 1.07, p = 0.001 & RR 1.08, p = 0.02) and fewer lifetime sunburns (RR 0.86, p < 0.001 & RR 0.91, p = 0.001). Higher resistance to sunburn was associated with lower total body (ß = - 0.006, p = 0.047) and femoral neck (ß = - 0.006, p = 0.038) BMD, but paradoxically, fewer prevalent fractures (RR 0.94, p = 0.042). Greater ability to tan was associated with higher 25OHD (ß = 1.43, p = 0.04), lumbar spine (ß = 0.014, p = 0.046) and total body (ß = 0.013, p = 0.006) BMD, but not fracture or falls risk. These associations were independent of constitutive melanin density. Cutaneous photosensitivity was associated with sun exposure behaviours, cutaneous sequelae and, consequently, 25OHD and BMD in older Caucasian adults independent of constitutive melanin density. There was no consistent association with fracture outcomes, suggesting environmental factors are at least as important.

Impacts of Seasonal Malaria Chemoprevention on Malaria Burden among under Five-Year-Old Children in Borno State, Nigeria.

Malaria disproportionately affects all ages with a high burden among children below five years. Thus, control measures are deployed including Seasonal Malaria Chemoprevention (SMC). The present study assessed the impacts of SMC on malaria burden among subjects aged 3-59 months in Borno State, Nigeria. Twenty (20) clusters were randomly selected from accessible 16 Local Government Areas (LGAs) of Borno State, Nigeria, and SMC was deployed in 10 of the clusters by administering a full dose of amodiaquine plus sulfadoxine-pyrimethamine at monthly intervals for 4 months consecutively. Three hundred and ninety-nine children were enrolled in the study. A structured questionnaire was used to obtain demographic and malaria-related data. Thick blood smear, thin blood smear, and capillary sample were collected two weeks after the 4th cycle of SMC. The prevalence of malaria and anaemia was determined among the subjects and for the clusters. The proportions of the female (46.4%; 185/399) and male (53.6%; 214/399) subjects were similar (p > 0.05) with subjects aged 24-47 months (35.8%; 143/399) accounting for the highest proportion (p < 0.05). Malaria prevalence was 10.3% (41/399) and was higher among non-SMC subjects (15.9%; 31/195) than among SMC subjects (4.9%; 10/204) (p < 0.05, df = 1, χ 2 = 10.8). Malaria prevalence was higher in non-SMC clusters (80.0%; 8/10) than in SMC clusters (30.0%; 3/10) (p < 0.05, df = 1, χ 2 = 40.5). The mean haematocrit of the 399 subjects was 34.0 ± 5.3% with an anaemia prevalence of 18.1% (72/399). The mean haematocrit was higher among SMC subjects (35.4 ± 5.0% vs. 33.1 ± 4.2%; p < 0.05) while anaemia prevalence was higher among non-SMC subjects (21.5% vs. 14.6%; p < 0.05, df = 1, χ 2 = 2.8). Of the SMC subjects, 4.9% reported adverse drug reactions. SMC is safe and significantly reduced malaria burden among children in Borno State, and thus, the measure could be deployed in the state for effective malaria control.

Constitutive melanin density is associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults.

Higher cutaneous melanin reduces vitamin D3 production. This may increase fracture risk. We found that cutaneous melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. Melanin density either acts as a surrogate marker or its relationship with fracture changes with time. INTRODUCTION: Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, prevalent and incident fractures in a cohort of exclusively older Caucasian adults. METHODS: 1072 community-dwelling adults aged 50-80 years had constitutive melanin density quantified using spectrophotometry. Participants were followed up at 2.5 (n = 879), 5 (n = 767), and 10 (n = 571) years after the baseline assessment. Prevalence and number of symptomatic fractures were assessed by questionnaire. RESULTS: Higher melanin density was independently associated with greater prevalence of any fracture (RR 1.08, p = 0.03), vertebral fracture (RR 1.41, p = 0.04) and major fracture (RR 1.12, p = 0.04) and the number of fractures (RR 1.09, p = 0.04) and vertebral fractures (RR 1.47, p = 0.04) in cross-sectional analysis. At the 2.5-year follow-up, higher melanin density was associated with incident fractures (RR 1.42, p = 0.01) and major fractures (RR 1.81, p = 0.01) and the number of incident fractures (RR 1.39, p = 0.02) and major fractures (RR 2.14, p = 0.01). The relationship between melanin density and incident fracture attenuated as the duration of follow-up increased and was not significant at the 5- or 10-year follow-up. CONCLUSIONS: Constitutive melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. This suggests melanin density either acts as a surrogate marker for an unmeasured fracture risk factor or the relationship between melanin density and fracture changes with time.

Prospective Associations of Low Muscle Mass and Function with 10-Year Falls Risk, Incident Fracture and Mortality in Community-Dwelling Older Adults.

OBJECTIVES: Purpose: To compare the performance of low muscle mass and function with falls risk, incident fracture and mortality over 10 years. METHODS: 1041 participants (50% women; mean age 63±7.5 years) were prospectively followed for 10 years. Falls risk was measured using the Physiological Profile Assessment, fractures were self-reported and mortality was ascertained from the death registry. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry. Four anthropometric: (ALM/height2, ALM/body mass index, ALM/weight×100, a residuals method of ALM on height and total body fat) and four performance-based measures: (handgrip strength, lower-limb muscle strength, upper and lower-limb muscle quality) were examined. Participants in the lowest 20% of the sex-specific distribution for each anthropometric and performance-based measure were classified has having low muscle mass or function. Regression analyses were used to estimate associations between each anthropometric and performance-based measure at baseline and 10-year falls risk, incident fractures and mortality. RESULTS: Mean falls risk z-score at 10 years was 0.64 (SD 1.12), incident fractures and mortality over 10 years were 16% and 14% respectively. All baseline performance-based measures were significantly associated with higher falls risk score at 10 years. Low handgrip (RR 1.55, 95% CI: 1.09, 2.20) and ALM/body mass index (RR 1.54, 95% CI: 1.14, 2.08) were the only significant predictors of fracture and mortality respectively. CONCLUSIONS: Low handgrip strength, a simple and inexpensive test could be considered in clinical settings for identifying future falls and fractures. ALM/ body mass index could be most suitable in estimating 10-year mortality risk, but requires specialised equipment.

Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria.

AIMS AND OBJECTIVES: The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population. PATIENTS AND METHODS: This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur. RESULTS: A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000. CONCLUSIONS: Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

Prevalence and Impact of Work-Related Musculoskeletal Disorders on Job Performance of Call Center Operators in Nigeria.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) have been documented among various occupational groups in Nigeria. However, there is limited data on the prevalence of WMSDs among call center operators (CCOs). OBJECTIVE: To determine the prevalence of WMSDs among CCOs in Nigeria and to explore the extent to which these discomforts impact the daily work activities of the respondents. METHODS: 374 respondents who were randomly selected from 4 telecommunication companies in Lagos State, Nigeria, participated in this study. They were asked to complete a pre-tested questionnaire designed to capture the prevalence, impact and associated risk factors of WMSDs among CCOs. RESULTS: 42% and 65.2% of respondents experienced at least one WMSDs in the past 7 days, and 12 months, respectively. Women and CCOs who received calls with hand-held phones rather than headsets reported more discomforts during both 7 days and 12 months periods. Neck, shoulder, upper back, and lower back were the most affected areas during past 7 days and 12 months. Discomforts in the neck, low back, and knees prevented most of the respondents from performing their daily work. CONCLUSION: WMSDs have a serious impact on the daily job activities of the CCOs in Nigeria.

Chemical constituents of Allophylus africanus.

Four new compounds, alloeudesmenol (1), hanocokinoside (3), allotaraxerolide (4), and alloaminoacetaldehyde (5), together with two known compound, stigmastane-3ß,4ß-diol (2) and pinitol 6 (a and b) were isolated and identified from the whole plant of Allophylus africanus.

Innovative interprofessional geriatric education for medical and nursing students: focus on transitions in care.

BACKGROUND: Interprofessional education (IPE) is crucial in fostering effective collaboration and optimal team-based patient care, all of which improve patient care and outcomes. Appropriate interprofessional communication is especially important in geriatrics where patients are vulnerable to adverse effects across the care continuum. Transitions in geriatric care are complex, involving several disciplines and requiring careful coordination. As part of the University of Virginia's initiative on IPE, we developed and implemented an interprofessional geriatric education workshop for nursing and medical students with a focus on transitions in care. METHODS: A total of 254 students (144 medical students, 107 nursing students and 3 unknown) participated in a 90-min interactive, case-based workshop. Nursing and medical faculty facilitated the monthly workshops with small groups of medical and nursing students over 1 year. Self-perceived competencies in IPE skills and attitudes toward interprofessional teamwork were measured through post-workshop surveys. Data were analyzed using descriptive and nonparametric statistics, excluding the three unknown students. RESULTS: Over 90% of students were better able to describe the necessary interprofessional communication needed to develop a patient-centered care plan in transitioning patients between clinical sites. Four out of five students reported an enhanced appreciation of interprofessional teamwork. They were also able to identify legal, financial and social implications in transitions of care (75%). Nursing students consistently rated the workshop more highly than medical students across most domains (P < 0.05). CONCLUSIONS: Students improved and demonstrated their knowledge of interprofessional communication and teamwork skills required in transitions of geriatric care. Introducing these concepts in medical and nursing training may help in fostering effective interprofessional communication and collaboration.

Patient reporting practices of suspected adverse drug reactions to antiretroviral drugs in a tertiary health facility in Nigeria.

AIMS AND OBJECTIVES: To assess the proportion of patients with suspected adverse drug reactions (ADRs) to highly active antiretroviral therapy (HAART) who reported the reactions to their healthcare providers and the factors associated with the reporting. PATIENTS AND METHODS: The study was conducted in the US President's Emergency Plan For AIDS Relief (PEPFAR) clinic at the University of Benin Teaching Hospital (UBTH), Benin City. The study population consisted of adult HIV infection patients receiving HAART at the clinic, who had suspected ADRs (SADRs). Using a systematic random sampling technique, patients were selected and interviewed with the aid of a structured questionnaire. The outcome measure was whether or not a SADR was reported to a healthcare provider. RESULTS: The study participants totalled 233, 171 (73.4%) of whom reported SADRs to their healthcare providers. Statistically significant difference was demonstrated with following higher-than-mean proportions of participants that reported SADRs: 100% (13/13) of respondents who experienced a SADR perceived to be life-threatening, (p=0.02; OR=0.00, 95%CI=0.00-0.87); 88.6% (31/35) of those who regarded their SADRs as severe (p=0.01; OR=4.02, 95%CI=1.28-16.63); and 95.2% (20/21) of those who had skin eruptions (p=0.02; OR=0.12, 95%CI=0.00-0.81). CONCLUSIONS: The finding that a high proportion of patients reported SADRs suggests that majority of patients contribute to pharmacovigilance and that they constitute opportunities for direct reporting of HAART-related ADRs to pharmacovilance centres. Facility-based pharmacovigilance desks should be set up and access should be created for patients to report SADRs directly. Healthcare providers should educate patients to report SADRs.

Resistant plasmid profile analysis of multidrug resistant Escherichia coli isolated from urinary tract infections in Abeokuta, Nigeria.

BACKGROUND: Multi-drug resistant Escherichia coli has become a major threat and cause of many urinary tract infections (UTIs) in Abeokuta, Nigeria. OBJECTIVES: This study was carried out to determine the resistant plasmids of multidrug resistant Escherichia coli isolated from (Urinary tract infections)UTIs in Abeokuta. METHODS: A total of 120 Escherichia coli isolates were obtained from urine samples collected from patients attending inpatient and outpatient clinics presenting UTI; with their biodata. Antibiotics susceptibility was performed and multi-drug resistant isolates were selected for plasmid profiling. Plasmids were extracted by the alkaline lysis method, electrophoresed on 0.8% agarose gel and profiled using a gel-photo documentation system gel. RESULTS: Escherichia coli isolates obtained shows high resistance to cloxacillin (92.5%), amoxicillin (90.8%), ampicillin (90.8%), erythromycin (75.8%), cotrimoxazole (70.0%), streptomycin (70.0%) and tetracycline (68.3%) while 85.8% and 84.2% were susceptible to gentamycin and ceftazidime respectively. Sixteen Escherichia coli strains were observed to be resistant to more than two classes of antibiotics. The resistant plasmid DNA was detectable in 6(37.5%) of the 16 multidrug resistant Escherichia coli having single sized plasmids of the same weight 854bp and were all resistant to erythromycin, cefuroxime, cloxacillin, amoxicillin, ampicillin and cotrimoxazole. CONCLUSION: This study has highlighted the emergence of multidrug resistant R-plasmids among Escherichia coli causing urinary tract infections in Abeokuta, Nigeria. There is a high level of resistance to many antimicrobials that are frequently used in Abeokuta, Nigeria.