Challenges to Thrombolysis in A Resource-Poor Setting- A Case Report.

A major complication of acute ischemic stroke is death and disability. The emergence of reperfusion therapy in form of thrombolysis and endovascular thrombectomy has led to the reversal of this trend in high-income countries. Low- and middle-income countries are yet to benefit maximally from these time-bound treatment options due to some limitations. We intend to highlight some of these in this report. We report an 80-year-old male patient with hypertension and firstdegree AV block admitted 3 hours after the onset of stroke with National Institutes of Health Stroke Scale (NIHSS) score of 13 and Medical Research Council (MRC) muscle power grade 3 in both the left upper and lower limb. Urgent non-contrast brain CT revealed no evidence of hemorrhage. Intravenous tissue plasminogen activator (tPA) was administered at a dose of 0.6 mg/kg 9 hours after symptom onset. He made significant improvement afterward and was discharged. The challenges encountered in his management include prehospital and intrahospital delay, and unavailability of tissue plasminogen activator. There is a need for an improved healthcare delivery system in order to reduce the morbidity associated with acute ischemic stroke.

Une complication majeure de l'accident vasculaire cérébral ischémique aigu est le décès et l'invalidité. L'émergence de la thérapie de reperfusion sous forme de thrombolyse et de thrombectomie endovasculaire a conduit à l'inversion de cette tendance dans les pays à revenu élevé. Les pays à revenu faible et moyen n'ont pas encore pleinement bénéficié de ces options de traitement limitées dans le temps en raison de certaines limitations. Nous avons l'intention de mettre en lumière certaines de ces limitations dans ce rapport. Nous rapportons le cas d'un homme de 80 ans, connu pour son hypertension et un bloc auriculo-ventriculaire de premier degré, admis 3 heures après le début de l'accident vasculaire cérébral avec un score de 13 à l'échelle d'AVC des National Institutes of Health (NIHSS) et une force musculaire du Medical Research Council (MRC) de grade 3 dans les membres supérieurs et inférieurs gauches. Une tomodensitométrie cérébrale urgente sans produit de contraste n'a révélé aucune preuve d'hémorragie. De l'activateur tissulaire du plasminogène (tPA) par voie intraveineuse a été administré à une dose de 0,6 mg/kg 9 heures après le début des symptômes. Il a ensuite connu une amélioration significative et a été autorisé à quitter l'établissement. Les défis rencontrés dans sa prise en charge comprenaient des retards préhospitaliers et intrahospitaliers, ainsi que l'indisponibilité de l'activateur tissulaire du plasminogène. Il est nécessaire d'améliorer le système de prestation de soins de santé afin de réduire la morbidité associée à l'accident vasculaire cérébral ischémique aigu. MOTS-CLÉS: Ischémique, AVC, Thrombolyse, Tissu, Plasminogène, Thrombectomie.

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.

Knowledge, Perceptions and Levels of Utilisation of E-Learning among Medical Students in Nigeria.

BACKGROUND: Globally, electronic learning (e-learning) is being embraced in all spheres, including the field of Medicine, where it has an engrained role in both medical education and practice. OBJECTIVES: The study aimed to assess the knowledge, perception and factors influencing the utilisation of e-learning amongst medical students in Nigeria. METHODS: It was a descriptive, cross-sectional survey. The study involved public and private medical schools across the six geopolitical zones of Nigeria. Five hundred and thirty (530) medical students responded to the online questionnaire (Google forms). Data were analyzed using SPSS version 23.0. RESULTS: The mean age of the participants was 21.5 ± 3.1 years, with 60.8% being females. About three-fifths (59.5%) of the respondents were in public universities, while the remaining were in private universities. Nearly all the respondents (98.1%) were aware of e-learning. The majority believed that e-learning would be useful for lectures and seminars, but not for laboratory demonstrations, clinical demonstrations, and bedside teaching. Class of study (p = 0.002), school ownership (p = 0.034), institutions having e-learning platform (p <0.001); having received e-learning training (p <0.001)) and institution encouraging e-learning for students (p <0.001) were significant predictors of utilization of e-learning. High cost and poor internet connectivity were the most cited disadvantages of e-learning. CONCLUSION: This study showed that e-learning is well known among Nigerian medical students, although some had never utilized it. The high financial costs, poor internet connectivity, and irregular electricity were among the major constraints to the utilization of e-learning.

CONTEXTE: Dans le monde entier, l'apprentissage électronique (elearning) est adopté dans toutes les sphères, y compris dans le domaine de la médecine, où il joue un rôle important dans l'enseignement et la pratique de la médecine. OBJECTIFS: L'étude visait à évaluer la connaissance, la perception et les facteurs influençant l'utilisation de l'apprentissage électronique chez les étudiants en médecine au Nigeria. MÉTHODES: Il s'agissait d'une enquête descriptive et transversale. L'étude a impliqué des écoles de médecine publiques et privées dans les six zones géopolitiques du Nigeria. Cinq cent trente (530) étudiants en médecine ont répondu au questionnaire en ligne (Google forms). Les données ont été analysées à l'aide de SPSS version 23.0. RÉSULTATS: L'âge moyen des participants était de 21,5 ± 3,1 ans,60,8 % étant des femmes. Environ trois cinquièmes (59,5 %) des répondants étaient dans des universités publiques, tandis que les autres étaient dans des universités privées. Presque tous les répondants (98,1 %) connaissaient l'apprentissage en ligne. La majorité d'entre eux pensaient que l'apprentissage en ligne serait utile pour les cours magistraux et les séminaires, mais pas pour les démonstrations en laboratoire, les démonstrations cliniques et l'enseignement au chevet des patients. La classe d'étude (p = 0,002), la propriété de l'école (p= 0,034), les institutions disposant d'une plateforme d'apprentissage électronique (p <0,001), ayant reçu une formation à l'apprentissage électronique (p <0,001)) et les institutions encourageant l'apprentissage électronique pour les étudiants (p <0,001) étaient des prédicteurs significatifs de l'utilisation de l'apprentissage électronique. Le coût élevé et la faible connectivité à internet étaient les inconvénients les plus cités de l'apprentissage en ligne. CONCLUSION: Cette étude a montré que l'apprentissage en ligne est bien connu parmi étudiants en médecine nigérians, même si certains ne l'ont jamais utilisé. Les coûts financiers élevés, la mauvaise connectivité à internet et l'irrégularité de l'électricité sont parmi les principales contraintes à l'utilisation de l'apprentissage en ligne. Mots Clés: Apprentissage en ligne, Connaissances, Étudiants en médecine, Nigeria, Utilisation.

HIV Knowledge and Screening Practices among In-School Adolescents in a Semi-Urban Community of Osun State, Southwest Nigeria.

BACKGROUND: Adolescents and youths are currently one of the main sub-populations responsible for most Human Immunodeficiency Virus (HIV) new cases in Nigeria due to their high-risk sexual practices. Yet, most Nigerian adolescents have poor HIV knowledge and are not aware of their HIV status. STUDY OBJECTIVES: We assessed respondents' HIV knowledge, their attitude to screening, testing practice and identified predictors of HIV screening among youths (15-24 years old) in Iwo, Osun State, Nigeria. METHODS: Cross-sectional design was employed and a multistage sampling method was used to recruit 360 eligible schooling youths in three secondary schools (private and public coeducational schools). A semi-structured, interviewer administered questionnaire was used for data collection. Both descriptive and inferential statistics were carried out at p<0.05. RESULTS: Mean age (±SD) of the respondents was 15±4.71 years. The majority (75.6%) of the respondents had heard about HIV. Overall, only 57.6% of respondents possessed a comprehensive knowledge of HIV but a majority (80.6%) of them had a positive attitude to HIV screening. Only 20.6% of the respondents had ever screened for HIV, 70.0% of them had pre-and post-test counselling. The most prevalent reason for non-screening is fear of getting a positive result (48.3%). Predictors of HIV screening uptakes included respondents' age (AOR = 2.95; 95%CI = 2.25-6.01), school type (AOR = 2.9;95%CI = 1.99-11.25), class level (AOR = 3.21;95% CI = 2.13-8.12) and attitude to screening (AOR = 2.51;95% CI = 2.01-6.39). CONCLUSION: Despite a high awareness rate and overwhelming positive attitude, HIV screening practice was low in the study setting. There is a need for health policymakers to further prioritise adolescents and youths in the race to end HIV epidemics in Nigeria.

CONTEXTE: Les adolescents et les jeunes sont actuellement l'une des principales sous-populations responsables de la plupart des nouveaux cas de virus de l'immunodéficience humaine (VIH) au Nigeria en raison de leurs pratiques sexuelles à haut risque. Pourtant, la plupart des adolescents nigérians ont une faible connaissance du VIH et ne sont pas conscients de leur statut sérologique. OBJECTIFS DE L'ÉTUDE: Nous avons évalué les connaissances des répondants sur le VIH, leur attitude à l'égard du dépistage, les pratiques de dépistage et identifié les facteurs prédictifs du dépistage du VIH chez les jeunes (15-24 ans) à Iwo, dans l'État d'Osun, au Nigeria. MÉTHODES: Une étude transversale a été employée et une méthode d'échantillonnage à plusieurs niveaux a été utilisée pour recruter 360 jeunes scolarisés éligibles dans trois écoles secondaires (privées et publiques). Un questionnaire semi-structuré, administré par un enquêteur, a été utilisé pour la collecte des données. Des statistiques descriptives et inférentielles ont été réalisées à p<0,05. RÉSULTATS: L'âge moyen (±SD) des personnes interrogées était de 15±4,71 ans. La majorité (75,6 %) des personnes interrogées avaient entendu parler du VIH. Dans l'ensemble, seulement 57,6 % des personnes interrogées avaient une connaissance approfondie du VIH, mais la majorité d'entre elles (80,6 %) avaient une attitude positive à l'égard du dépistage du VIH. Seules 20,6 % des personnes interrogées avaient déjà effectué un dépistage du VIH, mais 70 % d'entre elles avaient bénéficié d'un conseil avant et après le test. La raison la plus fréquente de l'absence de dépistage est la peur d'obtenir un résultat positif (48,3 %). Les facteurs prédictifs de la participation au dépistage du VIH comprenaient l'âge des répondants (AOR=2,95 ; 95%CI=2,25-6,01), le type d'école (AOR=2,9;95%CI=1,99-11,25), le niveau de classe (AOR=3,21;95% CI=2,13-8,12) et l'attitude à l'égard du dépistage (AOR=2,51;95% CI=2,01-6,39). CONCLUSION: Malgré un taux de sensibilisation élevé et une attitude très positive, la pratique du dépistage du VIH était faible dans le contexte de l'étude. Il est nécessaire que les décideurs en matière de santé accordent une plus grande priorité aux adolescents et aux jeunes dans la course à l'éradication de l'épidémie de VIH au Nigéria. Mots clés: VIH/SIDA, Adolescents, Jeunes, Jeunes, Nigeria.

10-Year Risk of Developing Type 2 Diabetes Mellitus: A Survey of Rural Communities in Southern Nigeria.

BACKGROUND: The exponential rise in the prevalence of Type 2 Diabetes (T2DM) necessitates the introduction of strategies for early diagnosis to reduce the burden of the disease. This study assessed the prevalence of prediabetes and also determined the 10-year risk of developing T2DM in Southern Nigerian rural communities by adopting the validated Finnish Diabetes Risk Score (FINDRISC) tool. METHODS: 273 participants from 3 Southern rural communities aged 18 years and older were recruited in this cross-sectional study. Data in the FINDRISC stratification tool and Random Blood Glucose (RBG) variables were obtained for the participants. IBM SPSS version 21 was used to analyze the data with a level of significance put at p < 0.05. RESULTS: The participants' mean age was 54.20±16.61 years. The prevalence of prediabetes among the study participants based on RBG was 4.8% (3.8% of males and 6.6% of females, respectively). Most of the study participants (41%) had a low risk of developing T2DM which meant that 1 in 100 participants would become diabetic in a 10-year period, based on the FINDRISC scale. Amongst the male participants, the Total Diabetes Risk Score (TDRS) showed significant positive correlation with the RBG (r=0.315, p=0.001); similarly, a weak positive correlation between TDRS and RBG was noted among female participants. CONCLUSION: The propensity of developing T2DM in 10 years was indisputably low amongst rural dwellers in the Southern Nigerian rural communities studied. Further studies to compare the risk of developing T2DM between rural and urban communities would be required.

CONTEXTE: L'augmentation exponentielle de la prévalence du diabète de type 2 (DT2) nécessite l'introduction de stratégies de diagnostic précoce pour réduire le fardeau de la maladie. Cette étude évalue la prévalence du prédiabète et détermine également le risque sur 10 ans de développer un DT2 dans les communautés rurales du sud du Nigeria en adoptant l'outil validé FINDRISC (Finnish Diabetes Risk Score). MÉTHODES: 273 participants de 3 communautés rurales du sud du pays âgés de 18 ans et plus ont été recrutés dans cette étude transversale. Les données de l'outil de stratification FINDRISC et les variables de la glycémie aléatoire (RBG) ont été obtenues pour les participants. IBM SPSS version 21 a été utilisé pour analyser les données avec un niveau de signification mis à p < 0,05. RÉSULTATS: L'âge moyen des participants était de 54,20±16,61 ans. La prévalence du prédiabète parmi les participants à l'étude, basée sur le RBG, était de 4,8% (3,8% des hommes et 6,6% des femmes respectivement). La plupart des participants à l'étude (41%) présentaient un faible risque de développer un DT2, ce qui signifie que 1 participant sur 100 deviendrait diabétique sur une période de 10 ans, selon l'échelle FINDRISC. Chez les hommes, le score total de risque de diabète (TDRS) a montré une corrélation positive significative avec le RBG (r=0,315, p=0,001) ; de même, une faible corrélation positive entre le TDRS et le RBG a été notée chez les femmes. CONCLUSION: La propension à développer un DT2 en 10 ans est indiscutablement faible chez les habitants des communautés rurales du sud du Nigeria étudiées. D'autres études visant à comparer le risque de développer un DT2 entre les communautés rurales et urbaines seraient nécessaires. Mots clés: FINDRISC, Nigeria, TDRS, Diabète de type 2, Prédiabète, Habitants ruraux.

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.

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.

Rabies virus infection is associated with alterations in the expression of parvalbumin and secretagogin in mice brain.

Infection with the deadly rabies virus (RABV) leads to alteration of cellular gene expression. The RABV, similar to other neurodegenerative diseases may be implicated in neuronal death due to an imbalance in Ca2+ homeostasis. Parvalbumin (PV) and Secretagogin (Scgn), two members of the Calcium-Binding Proteins (CBPs) are useful neuronal markers responsible for calcium regulation and buffering with possible protective roles against infections. This study investigated whether infection with rabies virus causes variance in expression levels of PV and Scgn using the Challenge virus standard (CVS) and Nigerian Street Rabies virus (SRV) strains. Forty-eight, 4-week-old BALB/c mice strains were divided into two test groups and challenged with Rabies virus (RABV) infection and one control group. The presence of RABV antigen was verified by direct fluorescent antibody test (DFAT) and real-time quantitative PCR (qRT-PCR) was used to assess PV and Scgn gene expression. Infection with both virus strains resulted in significant (p < 0.05) increases in expression during early infection. Mid-infection phase caused reduced expression for both genes. However, as infection progressed to the terminal phase, a lower increase in expression was measured. Gene expression and viral load correlation indicated no positive relationship. Neurons with these CBPs may have a greater capacity to buffer calcium and be more resistant to degenerative changes caused by RABV. This implies that, when PV and Scgn expression levels are kept adequately high, the integrity of neurons may be maintained and degeneration caused by RABV infection may be prevented or stopped, hence, these are possible constituents of effective rabies therapy.

Infant and Young Child Feeding Practices among Mothers of Children 6-23 Months Old Attending the Immunisation Clinic of a Private Tertiary Health Institution in Nigeria.

BACKGROUND: Globally, childhood malnutrition remains a major public health issue. It is thus imperative to contextually analyse Infant and Young Child Feeding (IYCF) practices in resource-poor settings like Nigeria. STUDY OBJECTIVES: This study assessed key complementary feeding indicators among 6-23-month-old children attending the immunization clinic of Bowen University Teaching Hospital, Ogbomoso, Nigeria. METHODOLOGY: Cross-Sectional design was employed, and Systematic Random Technique used to recruit 198 consenting caregivers. Validated interviewer-administered, semi-structured questionnaire was used for data collection. Both descriptive and inferential statistics were carried out. RESULTS: Mean±SD age of the children was 11.27±5.16 months. Only 57.6% of the infants had breastfeeding within 1-hour of life. Not less than 91.4% of the infants had Exclusive breastfeeding (EBF) but Infant formula was the main breastmilk substitute among children without EBF. In all, 83.0% of the infants had Minimum Meal Diversity, 90.4% had Minimum Meal Frequency but only 57.6% had Minimum Acceptable Diet (MAD). The significant predictors of MAD were early commencement of breastfeeding, reception of complementary feeding counselling during pregnancy, EBF practice and whether the child had MUAC which was at least 11cm. CONCLUSION: IYCF practices was sub-optimal in the studysetting. There is urgent need for policy makers to design evidence-informed strategic framework for effective implementation and evaluation of the existing IYCF policy in Nigeria. Emphasis should be placed on complementary feeding education/counselling using relevant Information, Education and Communication (IEC) channels/materials. Good IYCF practices ensure optimum child growth/ development, prevent childhood diseases, and can ultimately help Nigeria to attain SDG-3 by 2030.

CONTEXTE: À l'échelle mondiale, la malnutrition infantile reste un problème de santé publique majeur. Il est donc impératif d'analyser contextuellement les pratiques d'alimentation du nourrisson et du jeune enfant (ANJE) dans les milieux pauvres en ressources comme le Nigéria. OBJECTIFS DE L'ÉTUDE: Cette étude a évalué les principaux indicateurs d'alimentation complémentaire chez les enfants de 6 à 23 mois fréquentant la clinique de vaccination de l'hôpital universitaire de Bowen, Ogbomoso, Nigéria. MÉTHODOLOGIE: Une conception transversale a été utilisée et la technique aléatoire systématique a été utilisée pour recruter 198 soignants consentants. Un questionnaire semi-structuré et administré par un intervieweur a été utilisé pour la collecte des données. Des statistiques descriptives et inférentielles ont été réalisées. RÉSULTATS: L'âge moyen ± écart-type des enfants était de 11,27 ± 5,16 mois. Seulement 57,6% des nourrissons ont été allaités dans l'heure suivant la vie. Pas moins de 91,4% des nourrissons avaient l'allaitement maternel exclusif (EBF), mais les préparations pour nourrissons étaient le principal substitut du lait maternel chez les enfants sans EBF. En tout, 83,0% des nourrissons avaient une diversité minimale des repas, 90,4% avaient une fréquence minimale des repas, mais seulement 57,6% avaient un régime minimum acceptable (MAD). Les prédicteurs significatifs de la MAD étaient le début précoce de l'allaitement maternel, la réception de conseils d'alimentation complémentaire pendant la grossesse, la pratique de l'EBF et si l'enfant avait un PB d'au moins 11 cm. CONCLUSION: Les pratiques d'ANJE étaient sous-optimales dans le cadre de l'étude. Il y a un besoin urgent pour les décideurs politiques de concevoir un cadre stratégique fondé sur des données factuelles pour une mise en œuvre et une évaluation efficaces de la politique d'ANJE existante au Nigéria. L'accent doit être mis sur l'éducation /le conseil en alimentation complémentaire en utilisant les canaux /matériels d'information, d'éducation et de communication (IEC) pertinents. Les bonnes pratiques en ANJE garantissent une croissance/ un développement optimal de l'enfant, préviennent les maladies infantiles et peuvent finalement aider le Nigéria à atteindre l'ODD-3 d'ici 2030. MOTS CLÉS: Pratique d'alimentation des nourrissons, alimentationcomplémentaire, Fréquence minimale des repas, diversité minimaledes repas, Régime minimum acceptable, allaitement maternel exclusif.

Hypertension and its Clinical Correlates in a Rural Community in South Western Nigeria.

BACKGROUND: Hypertension is the commonest cardiovascular risk factor globally and is a cause of untold morbidity and mortality. However, its clinical correlates at the community level have not been well elucidated. METHODS: History taking, anthropometric measurements, electrocardiograms and laboratory investigations were done for all the study subjects. Ethical approval was obtained from the institution's ethical body. Analysis was done using SPSS version 20. Two hundred people were recruited for the study. The prevalence of hypertension in the community was 58.5% with 31(15.5%) being newly diagnosed. The Body Mass Index [BMI] (28.2±6vs 25.6±5.3; P=0.003),Waist-Hip ratio (0.9±0.08 vs 0.86±0.06; p= 0.001), total cholesterol (5.675±1.8 vs 4.6±1.7, P=0.000), triglycerides (1.19±0.85 vs 0.91±0.59; p=0.019), LDL cholesterol (3.38±1.6 vs 2.66±1.5; p=0.002), heart rate (82.4±15.8 vs 76.8±11.2; p=0.018) QRS duration (84.8±13.4 vs 80.5±11.2; p=0.040), and QTc (0.423±0.041 vs 0.402±0.035; p=0.001) were higher in those with hypertension. NYHA functional class was worse in hypertensives (p=0.041). Prevalence of left ventricular hypertrophy (LVH) in hypertensives ranged from 2.6 to 48.2%, depending on the criteria used. Systolic blood pressure, pulse pressures, HDL levels and hip circumferences were higher in those with electrocardiographic LVH. Systolic blood pressure (OR:1.045, P=0.006; CI: 1.013-1.079) and a normal BMI (OR: 0.159, p= 0.004; CI: 0.045-0.559) were the independent predictors of LVH in this study. CONCLUSION: The prevalence of hypertension is rising, even in rural populations, with accompanying LVH, higher QTc and florid cardiovascular risk factors. It is therefore imperative to tighten the reins of control of blood pressure and other cardiovascular risk factors before the cardiovascular morbidity and mortality explode in the rural communities.

CONTEXTE: L'hypertension est le facteur de risque cardiovasculaire le plus courant dans le monde et est une cause de morbidité et de mortalité indicibles. Cependant, ses corrélats cliniques au niveau communautaire n'ont pas été bien élucidés. MÉTHODES: Des antécédents, des mesures anthropométriques, des électrocardiogrammes et des examens de laboratoire ont été effectués pour tous les sujets de l'étude. L'approbation éthique a été obtenue de l'organe déontologique de l'institution. L'analyse a été effectuée à l'aide de la version 20 de SPSS. Deux cents personnes ont été recrutées pour l'étude. La prévalence de l'hypertension dans la communauté était de 58,5%, 31 (15,5%) nouvellement diagnostiqués. L'indice de masse corporelle [IMC] (28,2 ± 6 vs 25,6 ± 5,3; P = 0,003), le rapport taille-hanches (0,9 ± 0,08 vs 0,86 ± 0,06; p = 0,001), le cholestérol total (5,675 ± 1,8 vs 4,6 ± 1,7, P = 0,000), triglycérides (1,19 ± 0,85 vs 0,91 ± 0,59; p = 0,019), cholestérol LDL (3,38 ± 1,6 vs 2,66 ± 1,5; p = 0,002), fréquence cardiaque (82,4 ± 15,8 vs 76,8 ± 11,2; p = 0,018) Durée du QRS (84,8 ± 13,4 vs 80,5 ± 11,2; p = 0,040) et l'intervalle QTc (0,423 ± 0,041 vs 0,402 ± 0,035; p = 0,001) étaient plus élevés chez les personnes souffrant d'hypertension. La classe fonctionnelle NYHA était pire chez les hypertendus (p = 0,041). La prévalence de l'hypertrophie ventriculaire gauche (LVH) chez les hypertendus variait de 2,6 à 48,2%, selon la critères utilisés. La pression artérielle systolique, les pressions de pouls, les taux de HDL et la circonférence de la hanche étaient plus élevés chez les personnes atteintes de LVH électrocardiographique. La pression artérielle systolique (OR: 1,045, P = 0,006; IC: 1,013­1,079) et un IMC normal (OR: 0,159, p = 0,004; IC: 0,045­0,559) étaient les prédicteurs indépendants de l'HGV dans cette étude. CONCLUSION: La prévalence de l'hypertension est en hausse, même dans les populations rurales, accompagnée de LVH, d'un QTc plus élevé et de facteurs de risque cardiovasculaires florissants. Il est donc impératif de resserrer les rênes du contrôle de la pression artérielle et des autres facteurs de risque cardiovasculaire avant que la morbidité et la mortalité cardiovasculaires n'explosent dans les communautés rurales. Mots clés: Hypertension, hypertrophie ventriculaire gauche, indice de masse corporelle, HDL.

Risk of Obstructive Sleep Apnoea among Adults in a Rural Community in Southwest Nigeria.

BACKGROUND: Obstructive sleep apnoea (OSA) is a common medical condition which has long been recognized as a major contributor to morbidity and mortality in developed countries but that remains underdiagnosed, particularly in rural communities. This study aimed to assess the prevalence of adults who have a high risk of obstructive sleep apnoea in a sample of adults living in Ejigbo, a rural community in south western Nigeria. METHODS: This was a community-based cross-sectional descriptive study done to assess the prevalence of high risk of obstructive sleep apnoea in adult residents of the community using the STOP-BANG questionnaire. Data collected include socio-demographic characteristics, anthropometric measurements and blood pressure. A blood sample was also taken for lipid profile. Factors associated with a high risk of obstructive sleep apnoea were identified. RESULTS: The study involved 257 participants out of which 88 (34.2%) had a high risk of OSA. Risk of obstructive sleep apnoea was significantly associated with male sex (p<0.001), age (p<0.001), body mass index (BMI) (p=0.001), neck circumference (p<0.001), cigarette smoking (p=0.039) and low density lipoprotein (p=0.043). CONCLUSION: Obstructive sleep apnoea is relatively common in the study area. This calls for urgent preventive measures to stem the tide and mitigate the associated morbidity and mortality.

Cardiac autonomic neuropathy in adult epilepsy patients in a tertiary hospital in South-Western Nigeria.

BACKGROUND: Cardiac autonomic neuropathy (CAN) resulting from seizures has been implicated in sudden unexpected death in epilepsy in persons with epilepsy (PWE), however, there are no previous studies of CAN in PWE from Nigeria. OBJECTIVES: This study sought to determine the frequency and pattern of CAN in adult PWE in a tertiary hospital in South-western Nigeria and to determine the relationship between seizure variables and CAN. METHODS: A cross-sectional study of 80 adult PWE and 80 matched controls aged between 18 and 60 years was carried out between March 2012 and June 2013 at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Demographic and clinical data were obtained from all the study participants. Anxiety was excluded using the Hamilton Anxiety Scale. Those with conditions that could affect autonomic function, such as chronic renal failure, heart failure, Parkinson's disease, diabetes mellitus, anxiety, and psychiatric disorders and pregnant women were excluded. Five bedside cardiovascular reflex tests were performed on each subject after baseline heart rate and blood pressure (BP) had been recorded. RESULTS: The mean age of onset of epilepsy was 19 ± 10 years, whereas the mean duration of epilepsy was 10 ± 8 years. The mean seizure frequency was 14 ± 30 per month (median three seizures per month). Of the 80 patients evaluated, 42 (52.5%) had CAN, whereas none of the controls had CAN. Majority (69%) of the PWE with CAN had purely parasympathetic dysfunction, whereas 3% had purely sympathetic dysfunction and 10% had combined autonomic dysfunction. The PWE in this study had significantly lower tilt ratios and diastolic BP change with Isometric Hand grip as well as significantly higher systolic BP change on standing than the controls. Patients who had more than four seizures per month had higher odds of CAN than those with less frequent seizures (odds ratio 0.275, P value 0.023). Also, patients who had received treatment for less than 10 years were found to have greater odds of CAN than those who had received treatment for a longer period (odds ratio 11.676, P value 0.046). CONCLUSION: CAN is common in adult PWE in South-Western Nigeria and the major predictors are short duration of treatment and frequent seizure episodes. Routine screening of these patients may help with early detection of autonomic dysfunction and provide an opportunity for intervention.

Knowledge Attitude and Practices Toward Lassa Fever Control and Prevention Among Residents of Ile-Ife, Southwest Nigeria.

Lassa fever had been reported as a cause of death especially in endemic parts of Nigeria. This study assessed the knowledge, attitude, and practices toward Lassa fever control and prevention among residents of Ile-Ife, southwest Nigeria. Descriptive cross-sectional study was conducted among consenting randomly selected adults using an interviewer administered questionnaire. Data were analyzed using descriptive and inferential statistics. A total of 400 questionnaires with completed data were analyzed (response rate 96%). Majority, 207 (51.8%), were males while 193 (48.2%) were females. Most, 234 (58.5%), had tertiary education while 148 (37%) had secondary education. Fifty-nine percent had heard of Lassa fever with radio as their major source of information. About 76% had inadequate knowledge, 54% had negative attitude while 51% had poor practice toward Lassa fever. Determinants of knowledge of Lassa fever include having higher education (Adjusted Odd Ratio (AOR) = 11.49, 95% CI [3.10, 42.69], p = .0001), being in civil service (AOR = 0.22, 95% CI [0.09, 0.51], p = .01), and earning higher income (AOR = 4.23, 95% CI [2.61, 6.84], p = .0001). In conclusion, the knowledge, attitude, as well as preventive practices to Lassa fever were poor. It is necessary to increase public education and improve hygienic practices.

Knowledge, determinants and unmet needs for postpartum family planning use among women attending immunization clinic at Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria.

BACKGROUND: Most women in extended post partum period often have desire to use family planning. Disappointedly, majority of such women end up having unplanned or unwanted children. Little is currently known about factors responsible for such unmet family planning need among Nigerian women. OBJECTIVES: To assess the prevalence and determinants of unmet need for post partum family planning (PPFP) among women in Oyo State, south- west, Nigeria. METHODOLOGY: This cross-sectional analytic study was carried out using systematic sampling technique among 444 women attending immunization clinic in Ogbomoso, Nigeria. A pre-tested questionnaire was used for data collection and data analysis. was done using SPSS version 17. Chi-square test and binary logistic regression were used for analysis. RESULT: The mean age of the respondents was 36?9. Majority (65.7%) of the respondents demonstrated poor knowledge on PPFP. More than half (54.0%) of them had unmet need for limiting while 46.0% had unmet need for spacing. Fear of side effects was the commonest reason for lack of PPFP use (17.4%). Unmet need was significantly associated with marital status, educational status and level of awareness about PPFP. Level of awareness was the only significant predictor of unmet need among our study participants (OR; 2.973, 95% C.I; 0.119-0.459). CONCLUSION: Our study shows a high unmet need for PPFP among women in Ogbomoso, thus there is need for a more programmatic focus on women in their extended post partum periods. There is need for more awareness program on PPFP to increase contraceptive uptake in Nigeria.

Vitamin C supplementation promotes locomotor and exploratory behaviors in male Wistar rats exposed to varying stress models.

Constant exposure to environmental stress has negative behavioral outcomes. Considering the inverse relationship between stress and Vitamin C intake, this study was aimed at investigating variable stress techniques and Vitamin C supplementation on exploratory/locomotor behaviors in male Wistar rats. Twenty-eight male Sprague-Dawley rats (100g-120g) were allotted into four groups (n=7). Control received 10ml/kg distilled water, group two received 100 mg/kg vitamin C, group three was exposed to different models of stress while group four was stressed alongside 100 mg/kg vitamin C. Vitamin C treatments were given orally for 2 weeks. Animals in groups 3 and 4 were stressed every other day with models such as multiple cage changes, exposure to noise, overnight strange objects, overnight wetting of beddings, and immobility. Explorative and locomotor activities were assessed with the open field test, novel object recognition test, and Y maze test using a Logitech camera and ANY-maze software to track the movement of the rats. Cortisol was assayed in the serum using Enzyme-linked Immuno Assay (ELISA) kit. Superoxide Dismutase, catalase, and lipid peroxidase; malondialdehyde (MDA) were also assayed in the serum. The results show that locomotor activities such as distance traveled, average speed, and time spent in the center square was significantly reduced by stress. These activities were improved with the intake of vitamin C compared with stress. Explorative activities such as locomoting around the environment, orientating towards novelty, and touching or sniffing novel objects were significantly increased in the rats on Vitamin C supplements and reduced in the stressed group. In the serum, cortisol level was significantly increased in rats exposed to stress and decreased with Vitamin C intake. Stress also significantly increased MDA and decreased SOD and CAT while vitamin C supplement decreased MDA and increased SOD and CAT. In conclusion, oral intake of vitamin C enhanced explorative/locomotor behavior and increased oxidative stress in rats exposed to different models of stress.

Inhibitory mechanism of clioquinol and its derivatives at the exopeptidase site of human angiotensin-converting enzyme-2 and receptor binding domain of SARS-CoV-2 viral spike.

The outbreak of SARS-CoV-2 infections around the world has prompted scientists to explore different approaches to develop therapeutics against COVID-19. This study focused on investigating the mechanism of inhibition of clioquinol (CLQ) and its derivatives (7-bromo-5-chloro-8-hydroxyquinoline (CLBQ), 5, 7-Dichloro-8-hydroxyquinoline (CLCQ)) against the viral glycoprotein, and human angiotensin-converting enzyme-2 (hACE-2) involved in SARS-CoV-2 entry. The drugs were docked at the exopeptidase site of hACE-2 and receptor binding domain (RBD) sites of SARS-CoV-2 Sgp to calculate the binding affinity of the drugs. To understand and establish the inhibitory characteristics of the drugs, molecular dynamic (MD) simulation of the best fit docking complex performed. Evaluation of the binding energies of the drugs to hACE-2 after 100 ns MD simulations revealed CLQ to have the highest binding energy value of -40.4 kcal/mol close to MLN-7640 (-45.4 kcal/mol), and higher than the exhibited values for its derivatives: CLBQ (-34.5 kcal/mol) and CLCQ (-24.8 kcal/mol). This suggests that CLQ and CLBQ bind more strongly at the exopeptidase site than CLCQ. Nevertheless, the evaluation of binding affinity of the drugs to SARS-CoV-2 Sgp showed the drugs are weakly bound at the RBD site, with CLBQ, CLCQ, CLQ exhibiting relatively low energy values of -16.8 kcal/mol, -16.34 kcal/mol, -12.5 kcal/mol, respectively compared to the reference drug, Bisoxatin (BSX), with a value of -25.8 kcal/mol. The structural analysis further suggests decrease in systems stability and explain the mechanism of inhibition of clioquinol against SARS-CoV-2 as reported in previous in vitro study.Communicated by Ramaswamy H. Sarma.

Single-cell RNA seq analysis of erythroid cells reveals a specific sub-population of stress erythroid progenitors.

BACKGROUND: : Erythroid cells play important roles in hemostasis and disease. However, there is still significant knowledge gap regarding stress erythropoiesis. METHODS: : Two single-cell RNAseq datasets of erythroid cells on GEO with accession numbers GSE149938 and GSE184916 were obtained. The datasets from two sources, bone marrow and peripheral blood were analyzed using Seurat v4.1.1, and other tools in R. QC metrics were performed, data were normalized and scaled. Principal components that capture the variation of the data were determined. In clustering the cells, KNN graph was constructed and Louvain algorithm was applied to optimize the standard modularity function. Clusters were defined via differential expression of features. RESULTS: We identified 9 different cell types, with a particular cluster representing the stress erythroids. The clusters showed differentially expressed genes as observed from the gene signature plot. The stress erythroid cluster differentially expressed some genes including ALAS2, HEMGN, and GUK1. CONCLUSION: The erythroid population was found to be heterogeneous, with a distinct sub-cell type constituting the stress erythroids; this may have important implications for our knowledge of steady-state and stress erythropoiesis, and the markers found in this cluster may prove useful for future research into the dynamics of stress erythroid progenitor cell differentiation.

Prevalence of essential tremor in urban Lagos, Nigeria: a door-to-door community-based study.

BACKGROUND: Essential tremor (ET) is one of the commonest movement disorders though the prevalence varies globally. There is paucity of data on ET prevalence in sub-Saharan Africa. The study aimed to determine the prevalence of ET in a Nigerian community. METHODS: This door-to-door survey was conducted in two stages. In Stage 1, 3000 randomly selected residents of an urban centre in Lagos, Nigeria, were screened using a questionnaire to detect symptoms of movement disorder. 234 participants who responded positively regarding presence of tremors were rescreened using an ET-specific questionnaire, a face-to-face interview and neurological examination. Diagnosis of ET was based on the Movement Disorders Society (MDS) consensus diagnostic criteria for ET. RESULTS: Of the 3000 participants, forty responded positively to the ET screening questionnaire, of which 36 (19 females and 17 males) had a final diagnosis of ET, giving a crude prevalence of 12 per 1000 (95% CI = 8.1- 15.9). Gender specific prevalence was 10.3 /1000 in males and 14.3/1000 in females. Age specific prevalence increased with advancing age in both sexes. Age adjusted prevalence (WHO New world population) was 23.8 per 1000. CONCLUSIONS: We documented a high prevalence of ET in this study, with typical increasing prevalence with advancing age as previously reported in other populations.

Repurposing drugs and identification of inhibitors of integral proteins (spike protein and main protease) of SARS-CoV-2.

The outbreak of Coronavirus infection (COVID-19) has prompted the World Health Organisation (WHO) to declare the outbreak, a Public Health Emergency of International concern. As part of the efforts to discover lead compounds for clinical use, 53 molecules were screened using molecular docking and dynamic simulations (MDS) techniques to identify potential inhibitors of SARS-CoV-2 spike protein (COVID-19 Sgp) and main protease (COVID-19 Mpro) or both. Lopinavir (LPV), nelfinavir (NEF), hydroxychloroquine (HCQ), remdesivir (RDV) and an irreversible inhibitor of SARS-CoV (N3) were used as standard drugs for COVID-19 Mpro, while zafirlukast (ZFK) and cefoperazone (CSP)) as standard drugs for COVID-19 Sgp. After 100 ns of MDS, with reference to standard drugs (N3, -52.463 Kcal/mol, NEF, -51.618 Kcal/mol, RDV, -48.780 Kcal/mol, LPV, -46.788 Kcal/mol, DRV, -33.655 Kcal/mol and HCQ, -21.065 Kcal/mol), five molecules, HCR, GRN, C3G, EGCG, and K7G were predicted to be promising inhibitors of COVID-19 Mpro with binding energies of -53.877 kcal/mol, -50.653 Kcal/mol, -48.600 kcal/mol, -47.798 kcal/mol and -46.902 kcal/mol, respectively. These lead molecules were then docked at receptor-binding domain (RBD) of COVID-19 Sgp to examine their inhibitory effects. C3G, GRN and K7G exhibited higher binding energies of -42.310 kcal/mol, -32.210 kcal/mol, -26.922 kcal/mol than the recorded values for the reference drugs (CSP, -35.509 kcal/mol, ZFK, -24.242 kcal/mol), respectively. The results of the binding energy and structural analyses from this study revealed that C3G, GRN and K7G could serve as potential dual inhibitors of COVID-19 Sgp and COVID-19 Mpro, while HCR and EGCG would be inhibitors of COVID-19 Mpro.Communicated by Ramaswamy H. Sarma.

Inhibitory mechanism of Ambroxol and Bromhexine Hydrochlorides as potent blockers of molecular interaction between SARS-CoV-2 spike protein and human angiotensin-converting Enzyme-2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the host cells through interaction of its spike protein with human angiotensin-converting enzyme 2 (hACE-2). High binding affinity between the viral spike protein and host cells hACE-2 receptor has been reported to enhance the viral infection. Thus, the disruption of this molecular interaction will lead to reduction in viral infectivity. This study, therefore, aimed to analyze the inhibitory potentials of two mucolytic drugs; Ambroxol hydrochlorides (AMB) and Bromhexine hydrochlorides (BHH), to serve as potent blockers of these molecular interactions and alters the binding affinity/efficiency between the proteins employing computational techniques. The study examined the effects of binding of each drug at the receptor binding domain (RBD) of the spike protein and the exopeptidase site of hACE-2 on the binding affinity (ΔGbind) and molecular interactions between the two proteins. Binding affinity revealed that the binding of the two drugs at the RBD-ACE-2 site does not alter the binding affinity and molecular interaction between the proteins. However, the binding of AMB (-56.931 kcal/mol) and BHH (-46.354 kcal/mol) at the exopeptidase site of hACE-2, significantly reduced the binding affinities between the proteins compared to the unbound, ACE-2-RBD complex (-64.856 kcal/mol). The result further showed the two compounds have good affinity at the hACE-2 site, inferring they might be potent inhibitors of hACE-2. Residue interaction networks analysis further revealed the binding of the two drugs at the exopeptidase site of hACE-2 reduced the number of interacting amino residues, subsequently leading to loss of interactions between the two proteins, with BHH showing better reduction in the molecular interaction and binding affinity than AMB. The result of the structural analyses additionally, revealed that the binding of the drugs considerably influences the dynamic of the complexes when compared to the unbound complex. The findings from this study suggest the binding of the two drugs at the exopeptidase site reduces the binding effectiveness of the proteins than their binding at the RBD site, and consequently might inhibit viral attachment and entry.