Patient Satisfaction with Care and Its Predictors in a Secondary Hospital in Kaduna State, North-western Nigeria.

BACKGROUND: Satisfied patients adhere more to counselling, prescribed treatment and referrals. Few studies reveal the sub-scales of satisfaction and predictors of satisfaction in north-western Nigeria. OBJECTIVES: To determine patients' overall satisfaction with healthcare provision and their predictors at a secondary hospital in Kaduna metropolis, Kaduna State, North-Western Nigeria. METHODS: A descriptive, cross-sectional exit survey of 390 consenting patients selected by systematic sampling from outpatient clinics in June 2022. The data collection tool was a standardized, structured questionnaire electronically administered using the "Kobo Collect" app. Data were analysed using SPSS (version 23); the chi- square (x ) test was used for bivariate analysis (at P<0.05) and ordinal regression (using the generalized linear model method) was used to determine predictors of satisfaction. RESULTS: The general satisfaction among respondents was 60.5%; age, sex, highest education attained and employment status were significantly associated with general satisfaction (p<0.05). Positive predictors of satisfaction were financial aspects, time spent with doctors, communication as well as accessibility and convenience. CONCLUSION: Patients' overall satisfaction was above average. Predictors of satisfaction included financial aspects, time spent with doctors, communication, accessibility and convenience. Careful attention to these domains will enhance patient satisfaction with care in our secondary hospitals.

CONTEXTE: Les patients satisfaits adhèrent davantage aux conseils, aux traitements prescrits et aux recommandations. Peu d'études révèlent les sous-échelles de satisfaction et les prédicteurs de satisfaction dans le nord-ouest du Nigeria. OBJECTIFS: Déterminer la satisfaction globale des patients à l'égard de la prestation de soins de santé et leurs prédicteurs dans un hôpital secondaire de la métropole de Kaduna, dans l'État de Kaduna, au nord-ouest du Nigeria. MÉTHODES: Enquête de sortie descriptive et transversale menée auprès de 390 patients consentants sélectionnés par échantillonnage systématique dans des cliniques externes en juin 2022. L'outil de collecte de données était un questionnaire standardisé et structuré administré électroniquement à l'aide de l'application "Kobo Collect". Les données ont été analysées à l'aide du logiciel SPSS (version 23); le test du chi carré (χ2) a été utilisé pour l'analyse bivariée (à P<0.05) et la régression ordinale (en utilisant la méthode du modèle linéaire généralisé) a été utilisée pour déterminer les prédicteurs de satisfaction. RÉSULTATS: La satisfaction générale des répondants était de 60,5 %; l'âge, le sexe, le niveau d'éducation le plus élevé atteint et le statut d'emploi étaient significativement associés à la satisfaction générale (p<0,05). Les prédicteurs positifs de satisfaction étaient les aspects financiers, le temps passé avec les médecins, la communication ainsi que l'accessibilité et la commodité. CONCLUSION: La satisfaction globale des patients était au-dessus de la moyenne. Les prédicteurs de satisfaction comprenaient les aspects financiers, le temps passé avec les médecins, la communication, l'accessibilité et la commodité. Une attention particulière à ces domaines améliorera la satisfaction des patients à l'égard des soins dans nos hôpitaux secondaires. MOTS-CLÉS: Satisfaction des patients, Satisfaction à l'égard des soins, Prédicteurs, Temps passé avec les médecins.

Racial disparities in COVID-19 hospitalizations do not lead to disparities in outcomes.

OBJECTIVES: The objective of the study is the identification of racial differences in characteristics and comorbidities in patients hospitalized for COVID-19 and the impact on outcomes. STUDY DESIGN: The study design is a retrospective observational study. METHODS: Data for all patients admitted to seven community hospitals in Michigan, United States, with polymerase chain reaction confirmed diagnosis of COVID-19 from March 10 to April 15, 2020 were analyzed. The primary outcomes of racial disparity in inpatient mortality and intubation were analyzed using descriptive statistics and multivariate regression models. RESULTS: The study included 336 Black and 408 White patients. Black patients were younger (62.9 ± 15.0 years vs 71.8 ± 16.4, P < .001), had a higher mean body mass index (32.4 ± 8.6 kg/m2 vs 28.8 ± 7.5, P < .001), had higher prevalence of diabetes (136/336 vs 130/408, P = .02), and presented later (6.6 ± 5.3 days after symptom onset vs. 5.4 ± 5.4, P = .006) compared with White patients. Younger Black patients had a higher prevalence of obesity (age <65 years, 69.9%) than older Black patients (age >65 years, 39.2%) and younger White patients (age < 65, 55.1%). Intubation did not reach statistical significance for racial difference (Black patients 61/335 vs. 54/406, P = .08). Mortality was not higher in Black patients (65/335 vs. 142/406 in White patients, odds ratio 0.61, 95% confidence interval: 0.37 to 0.99, 2-sided P = .05) in multivariate analysis, accounting for other risk factors associated with mortality. CONCLUSIONS: Higher prevalence of obesity and diabetes in young Black populations may be the critical factor driving disproportionate COVID-19 hospitalizations in Black populations. Hospitalized Black patients do not have worse outcomes compared with White patients.

Predictors of drug retention and treatment response in axial spondyloarthritis patients treated with certolizumab: real-life results from the HURBIO registry.

OBJECTIVES: To assess the real-life retention rate of certolizumab and factors related to retention of certolizumab. METHODS: We analysed all patients who received at least 1 dose of certolizumab and were registered in the HURBIO database. Patients with at least 1 control visit were included in efficacy analysis. Drug retention rates were calculated using the Kaplan-Meier method and predictors of drug retention was determined by Cox proportional hazard model. Factors predicting BASDAI50 response at first visit were analysed by the logistic regression analysis. Reasons of switching and discontinuation were also determined. RESULTS: A total of 325 (AS (76%), female 55%) patients were recruited. Median follow-up while receiving certolizumab was 13 (4.7-22.7) months. At 1 year, overall certolizumab retention rate was 72.5%. Predictors of poor certolizumab retention were: Current or ex-smoker [HR 1.11 (0.70-1.76), p=0.65], high CRP levels [HR 0.72 (0.45-1.16), p=0.18], biologic-naïve [HR 0.81 (0.49-1.32), p=0.39] and good BASDAI50 response at first control visit [HR 0.54 (0.30-0.96), p=0.04]. Mean duration from starting certolizumab to the first control visit was 3 (3-6) months. Predictors of poor BASDAI50 response: Presence of nr-axSpa [RR 2.12 (1.01-4.51), p=0.05], female gender [RR 2.14 (1.20-3.82), p=0.01] and history of biologic therapy [RR 3.52 (1.95-6.33), p<0.001]. The most common causes of drug switch were primary failure and drug side-effects. CONCLUSIONS: In this study, good BASDAI50 response at first visit seems to be a strong predictor of higher retention of certolizumab in patients with axial spondyloarthritis.

Determinants of health-related quality of life among human immunodeficiency virus positive (HIV-positive) patients at Ahmadu Bello University teaching hospital, Zaria, Nigeria- 2015.

BACKGROUND: The advent of Highly Active Antiretroviral Therapy (HAART) is associated with improved clinical and laboratory outcomes resulting in prolonged life and well-being of people living with Human Immunodeficiency Virus (PLHIV). However, the needs for life-long therapy, medications' side effects and stigma have raised concerns about their quality of life (QOL). This study assessed the determinants of Health-related quality of life (HRQOL) among HIV-positive patients at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. METHODS: We conducted a cross-sectional study of 353 HIV-positive adults on HAART attending the HIV clinic of ABUTH, Zaria. The participants were recruited into the study using a systematic sampling technique. Data on socio-demographics, medical parameters, QOL and family functionality were collected using structured, interviewer-administered questionnaire. The World Health Organization (WHO) Quality of Life HIV short form instrument (WHOQOL-HIV BREF) item and Family APGAR tool were respectively used in assessing the QOL and family functionality of the participants. We performed univariate, bivariate and multivariate analysis. RESULTS: Mean age was 39.1(±10.9) years, 239 (67.7%) were females, 208 (58.9%) were Hausa-Fulani, 240 (68.2%) married and up to 210 (59.4%) had at least a secondary education. The overall mean scores on the scale of 4-20 for HRQOL were similar in three domains: environment domain 14.5(±2.8); social relationship 14.4(±3.1) and level of independence 14.4(±2.5). Lower scores were recorded in spirituality/religion/personal beliefs 12.3(±4.3). Identified determinants of HRQOL were spousal HIV- positive status (AOR = 3.37; CI; 1.46-7.74) and high family function (AOR = 2.57; CI: 1.51-4.39). CONCLUSION: Having highly functional family and having HIV-positive partner were the major determinants of HRQOL. Routine family counselling and strengthening the HIV social-support network should be incorporated into the routine patients' care in HIV treatment centers.

Avascular necrosis less frequently found in systemic lupus erythematosus patients with the use of alternate day corticosteroid

Background/aim: Avascular necrosis (AVN) is the death of bone due to compromise of blood flow. The etiology of AVN is multifactorial; corticosteroid usage is the second most significant factor after trauma, and systemic lupus erythematosus (SLE) is the most common underlying disease. The objective of this study was to assess the factors of AVN in SLE patients. Materials and methods: The study included 127 patients with SLE who fulfilled 1997 American College of Rheumatology (ACR) revised criteria. Demographic data, age at SLE diagnosis, disease duration, disease activity, body mass index, clinical findings, antiphospholipid syndrome, steroid usage, dose and duration, comorbid diseases, and smoking history were recorded. Results: AVN was found in 11 of 127 (8.7%) SLE patients. Hyperlipidemia (P < 0.001), cushingoid body habitus (P < 0.001), and proteinuria (P = 0.013) were found at higher rates in the AVN group. All of the 11 AVN cases had osteoporosis (P < 0.02). In multivariate regression analysis, daily steroid usage was the only factor for development of AVN in SLE. Conclusion: The hypothesis of our study was that an alternate day steroid regimen may decrease AVN frequency in SLE patients.

Divergent subcortical activity for distinct executive functions: stopping and shifting in obsessive compulsive disorder.

BACKGROUND: There is evidence of executive function impairment in obsessive compulsive disorder (OCD) that potentially contributes to symptom development and maintenance. Nevertheless, the precise nature of these executive impairments and their neural basis remains to be defined. METHOD: We compared stopping and shifting, two key executive functions previously implicated in OCD, in the same task using functional magnetic resonance imaging, in patients with virtually no co-morbidities and age-, verbal IQ- and gender-matched healthy volunteers. The combined task allowed direct comparison of neural activity in stopping and shifting independent of patient sample characteristics and state variables such as arousal, learning, or current symptom expression. RESULTS: Both OCD patients and controls exhibited right inferior frontal cortex activation during stopping, and left inferior parietal cortex activation during shifting. However, widespread under-activation across frontal-parietal areas was found in OCD patients compared to controls for shifting but not stopping. Conservative, whole-brain analyses also indicated marked divergent abnormal activation in OCD in the caudate and thalamus for these two cognitive functions, with stopping-related over-activation contrasting with shift-related under-activation. CONCLUSIONS: OCD is associated with selective components of executive function, which engage similar common elements of cortico-striatal regions in different abnormal ways. The results implicate altered neural activation of subcortical origin in executive function abnormalities in OCD that are dependent on the precise cognitive and contextual requirements, informing current theories of symptom expression.

Management of the mass casualty from the 2001 Jos crisis.

BACKGROUND: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. MATERIALS AND METHODS: A retrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care. RESULTS: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients. Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside. CONCLUSION: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.

Factors that predict development of chronic kidney disease in patients with rheumatoid arthritis receiving biologic DMARDs and mortality rates.

OBJECTIVES: We aimed to determine the choice of biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/ts-DMARDs), factors associated with the development of chronic kidney disease (CKD), and mortality in RA patients with CKD receiving b/ts-DMARDs. METHODS: Two thousand one hundred forty-one RA (79.4% female) patients were included in the analysis from the HUR-BIO prospective registry. Patients were divided into the CKD group and the non-CKD group. Age and gender-matched patients were selected from the non-CKD group, and then three main groups were determined. CKD was staged according to the glomerular filtration rate criteria. The clinical characteristics of the patients, disease activities, treatment choices, drug retention rate, and mortality rates were compared between the groups. RESULTS: CKD was detected in 90/2141 (4.2%) RA patients on b/ts-DMARDs. Forty patients (2.3%) developed CKD during follow-up after the initiation of b/ts-DMARDs. In the CKD group, anti-TNF agents were chosen as the first-line b/ts-DMARDs therapy in 64.4% of patients, with etanercept leading in 31 (34.4%) patients. In multivariate analysis, age at the start of treatment, DAS-28-ESR at last visit, amyloidosis, hypertension, and history of smoking were the factors associated with the development of CKD in RA patients receiving b/ts-DMARDs. The mortality rate in RA-CKD patients until the onset of the pandemic was 15.41 per 1000 patient years, whereas it was 85.9 per 1000 patient years after the pandemic. CONCLUSION: Comorbidities and control of disease activity are critical in the development of CKD in RA patients receiving b/ts-DMARDs. While there was no significant difference in mortality rate between CKD and non-CKD patients, the overall mortality rate increased after the COVID-19 pandemic duration in both groups.

The conundrum of polytrauma on the jos plateau.

BACKGROUND: The leading cause of morbidity and mortality from the end of the first year of life to the forty fifth is trauma. This is true worldwide but especially so in our environment. In no other situation are the complexities of the management of trauma more manifest than in the context of polytrauma. For this we undertake to study the problem of polytrauma in Jos. AIMS AND OBJECTIVES: To determine the frequency and pattern of occurrence of poly trauma in Jos university teaching hospital. PATIENTS AND METHODS: Consecutive patients presenting with polytrauma to the casualty department were prospectively studied. Data regarding demographics and a detailed description of injuries were entered into a proforma and collated over a one-year period. RESULTS: A total of 131 patients were studied. There were 103 males and 28 females giving a male to female ratio of 3.7:1. The ages ranged from 2 to 61 years with a mean of 28.4 ± 12.4 years. Road traffic accident was the most common aetiology in 113 (86.3%) patients, while falls 7 (5.3%), gunshots 5 (3.8%) and assaults 2 (1.6%) were observed. The most frequently encountered injuries were head, extremity and chest in 71.8%, 68.5% and 29.2% respectively. The combinations most frequently observed were head\extremity (43.5%), head\chest (17.6%) and chest\extremity (10.7%) injuries. Complications were observed in 20.6% while death occurred in 7.6%. CONCLUSION: Polytrauma occurs with sufficient frequency to warrant serious attention. As majority follow RTA, there is a need to intensify measures aimed at improving road safety. There is also a need to establish pre-hospital care\ambulance services. It is suggested that improved orthopaedic and neurosurgical care will lead to improved polytrauma care and most importantly, the establishment of dedicated trauma teams in tertiary institutions is proposed as a prelude to the establishment of regional trauma centers.

Drug therapy and medication adherence in type 2 diabetes in a care facility: A cross sectional survey.

Background: Adherence to medications improves glycaemic control and reduces diabetes-related morbidity and mortality. Objectives: The study assessed drug therapy for type 2 diabetes, glycaemic control and association of medication adherence with socio-demographic and clinical data, among adult diabetic patients attending a healthcare facility. Methods: Cross-sectional survey and hospital records were used to obtain data. The study included 200 adults with type 2 diabetes mellitus in a Nigerian healthcare facility. Data on patients clinical characteristics, diabetes drug therapy and medication adherence were collected, entered and anlaysed using SPSS version 24 (P < 0.05). Primary outcome measure was medication adherence among the patients, while secondary outcome measures was glycaemic control. Results: A total of 200 (100%) respondents participated in the study and the majority 141(70.5%) were over 60 years old. Oral medications were mostly used 187(93.5%), particularly, metformin 199(99.5%) and pioglitazone 100(50.0%), while dipeptidyl peptidase-4 inhibitors were not used at all. Patients mostly had poor glycaemic control 159 (79.5%) and majority 152(76.0%) did not practice self-blood glucose monitoring. Moderate medication adherence was predominant in the population. Class of medicine and socio-demographics were not significantly associated with medication adherence (P > 0.05), unlike results of blood glucose self-tests (p = 0.001). Conclusion: Oral antidiabetics, particularly metformin and pioglitazone were mostly used. Poor glycaemic control and moderate adherence were found in the patients, and medication adherence was associated with self-glucose monitoring. This emphasises the need for regular diabetes education on medication adherence.

Pharmacy students' perceptions on the health and pharmaceutical care needs of older adults.

INTRODUCTION: Perceptions of pharmacy students as future health care providers can enhance the health and pharmaceutical care (PC) needs of older adults. The objective of this study was to investigate pharmacy students' awareness and perceptions of the health and PC needs of older adults. METHODS: A cross-sectional survey was conducted among pharmacy students in Southwest, Nigeria for four weeks using a 39-item structured questionnaire. Unpaired t-tests and one-way analysis of variance were performed. A P < .05 was considered significant. RESULTS: Based on 422 completed questionnaires, 299 (70.9%) were females, 283 (67.1%) were 20 to 24 years, 123 (29.2%) were in 200 Level, 402 (95.3%) had heard of PC with their first source of information being pharmacy school, 352 (83.4%). Reliability of the instrument was 0.92 (Cronbach's alpha). Mean + SD of pharmacy students' perceived health and PC needs of older adults were 3.73 ±â€¯1.176 and 4.21 ±â€¯1.031, respectively. The majority, 355 (84.2%), agreed on the importance of health care providers understanding their geriatric patients' family circumstances and social environment and 381 (90.3%) perceived that such will strengthen their professional relationship with older adults. CONCLUSIONS: Pharmacy students were aware of PC and indicated positive attitudes towards caring for older adults but few had provided care. Reinforcement of PC training and emphasis on geriatric topics in pharmacy curriculum are reiterated.

Pharmacy graduates' perceptions of competency, integration, and social accountability in the undergraduate curriculum of pharmacy schools in Nigeria.

INTRODUCTION: An integrated, competency-based curriculum that fosters social accountability including cultural sensitivity among graduates is an educational strategy towards producing practice-ready professionals. This study aimed to evaluate pharmacy graduates' perceptions of competency, integration, and social accountability in the undergraduate curriculum of Nigerian schools of pharmacy. METHODS: A cross-sectional online survey consisting of a 42-item questionnaire was administered to 467 purposively selected pharmacy graduates who completed their undergraduate training between January 2012 and February 2020 from 20 accredited Nigerian pharmacy schools. Mann-Whitney U test was used to determine the differences in the participants' responses on a Likert scale. RESULTS: Of 467 participants, 54.4% felt that the Nigerian undergraduate pharmacy curriculum was not adequate in content, while 54.2% felt the courses in the curriculum were not well integrated to facilitate easy learning by students. About half (50.6%) strongly agreed or agreed that "the basic pharmacy courses are well synchronized with the clinical components" but 28.9% strongly disagreed or disagreed. The majority (88%), with no significant difference between gender (z = -1.615, P = .11), strongly agreed or agreed that they apply knowledge of clients' culture and disparity to deliver pharmaceutical services. CONCLUSIONS: Marginally above half of the graduates perceived the Nigerian undergraduate pharmacy curriculum to be deficient in course content. There is evidence of limited integration and social accountability in the curriculum. Cultural sensitivity appears to be a component of the curriculum but this needs to be properly structured. The pedagogy strategy for learning cultural sensitivity should be further interrogated.

Comparative pathology, molecular pathogenicity, immunological features, and genetic characterization of three highly pathogenic human coronaviruses (MERS-CoV, SARS-CoV, and SARS-CoV-2).

The last two decades have witnessed the emergence of three deadly coronaviruses (CoVs) in humans: severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There are still no reliable and efficient therapeutics to manage the devastating consequences of these CoVs. Of these, SARS-CoV-2, the cause of the currently ongoing coronavirus disease 2019 (COVID-19) pandemic, has posed great global health concerns. The COVID-19 pandemic has resulted in an unprecedented crisis with devastating socio-economic and health impacts worldwide. This highlights the fact that CoVs continue to evolve and have the genetic flexibility to become highly pathogenic in humans and other mammals. SARS-CoV-2 carries a high genetic homology to the previously identified CoV (SARS-CoV), and the immunological and pathogenic characteristics of SARS-CoV-2, SARS-CoV, and MERS contain key similarities and differences that can guide therapy and management. This review presents salient and updated information on comparative pathology, molecular pathogenicity, immunological features, and genetic characterization of SARS-CoV, MERS-CoV, and SARS-CoV-2; this can help in the design of more effective vaccines and therapeutics for countering these pathogenic CoVs.

Exsanguinating blunt breast trauma: a report of a rare injury.

We report a rare case of blunt trauma in a non-augmented multiparous breast of a young Nigeria woman with exsanguinating haemorrhage who had no clotting disorder. She had no seatbelt on at the time of injury and the car was not fitted with air bag device. Prompt surgical intervention to control haemorrhage from the breast was essential in saving her life. Reasons are advanced why this injury is uncommon.

The knowledge, awareness, and perception of healthcare professionals about appropriate prescribing in the elderly: Findings from Nigeria and South Africa.

RATIONALE, AIMS, AND OBJECTIVES: Inappropriate prescribing is associated with preventable morbidity and mortality in the elderly. The American Geriatrics-Beers (AGS-Beers) Criteria was developed to guide healthcare professionals (HCPs) to prescribe medications appropriately in the elderly. However, there is a dearth of information about the knowledge and awareness of HCPs of these criteria, and their perceptions of appropriate prescribing in the elderly. This study aimed to evaluate the knowledge and perceptions of Nigerian and South African HCPs about appropriate prescribing in the elderly. METHOD: A 32-item questionnaire was self-administered among consecutively selected HCPs (physicians, nurses, and pharmacists) in one teaching hospital each in Nigeria and South Africa. Seven questions including six clinical vignettes from the 2015 AGS-Beers Criteria were used to assess the participants' knowledge.The participants' knowledge was classified based on the total score as poor (0-3), fair (4, 5), and good (6, 7). The HCPs' perceptions of appropriate prescribing in the elderly were evaluated using a 5-point Likert scale. Mann-Whitney U test was used to evaluate ranked variables at P < .05. RESULTS: A total of 369 participants, 62.9% (232/369) mean age 42.75(9.35) years in Nigeria and 37.1% (137/369), mean age 38.66 (7.76) years, (CI = 2.32-5.87, P < .001) in South Africa were evaluated. Many participants in Nigeria (52.6%) and 48.2% in South Africa had scores (4, 5).The majority of the participants (57.3%) in Nigeria and 67.2% in South Africa were not aware of any explicit criteria for prescribing to the elderly while 45.8% of the total participants with no significant difference between the groups (P = .332) "strongly agreed" or "agreed" that the basic professional training is adequate for prescribing medicines to the elderly. CONCLUSIONS: Many HCPs in Nigeria and South Africa had a fair knowledge of appropriate prescribing to the elderly and considered basic professional training as adequate for appropriate prescribing to the elderly.

Effects of oxytocin administration on salivary sex hormone levels in autistic and neurotypical women.

BACKGROUND: Oxytocin administration, which may be of therapeutic value for individuals with social difficulties, is likely to affect endogenous levels of other socially relevant hormones. However, to date, the effects of oxytocin administration on endogenous hormones have only been examined in neurotypical individuals. The need to consider multi-hormone interactions is particularly warranted in oxytocin trials for autism due to evidence of irregularities in both oxytocin and sex steroid systems. METHODS: In this double-blind cross-over study, saliva samples were collected from 16 autistic and 29 neurotypical women before and after intranasal administration of 24 IU oxytocin or placebo. Oestradiol, testosterone, and oxytocin levels were quantified in saliva samples. Participants also completed the Autism-Spectrum Quotient (AQ) and Empathy Quotient (EQ) questionnaires. RESULTS: Distinct patterns of change in testosterone and oestradiol levels pre- to-post-administration were observed in autistic relative to neurotypical women (ANCOVA, p < 0.05 main effect of Group), controlling for sample collection time. The mean percent change oestradiol was + 8.8% for the autism group and - 13.0% for the neurotypical group (t = 1.81, p = 0.08), while the mean percent change testosterone was + 1.1% in the autism group and - 12.6% in the neurotypical group (t = 1.26, p = 0.22). In the oxytocin condition, the mean percent change oestradiol was + 12.6% in the autism group and - 6.9% in the neurotypical group (t = 1.78, p = 0.08), while the mean percent change testosterone was + 14.4% in the autism group and - 15.2% in the neurotypical group (t = 3.00, p = 0.006). Robust regression confirmed that group differences in percent change hormone levels were not driven by a small number of influential individuals. Baseline hormone levels did not differ between groups when considered individually. However, baseline testosterone relative to oestradiol (T:E2 ratio) was higher in autistic women (p = 0.023, Cohen's d = 0.63), and this ratio correlated positively and negatively with AQ and EQ scores, respectively, in the combined sample. LIMITATIONS: Further studies with larger and more diverse autistic sample are warranted to confirm these effects. CONCLUSIONS: This study provides the first evidence that oxytocin influences endogenous testosterone levels in autistic individuals, with autistic women showing increases similar to previous reports of neurotypical men. These findings highlight the need to consider sex steroid hormones as a variable in future oxytocin trials.

Prophylactic use of lamivudine with chronic immunosuppressive therapy for rheumatologic disorders.

The objective of this study was to report our experience concerning the effectiveness of the prophylactic administration of lamivudine in hepatitis B virus surface antigen (HBs Ag) positive patients with rheumatologic disease. From June 2004 to October 2006, 11 HBs Ag positive patients with rheumatologic diseases, who were on both immunosuppressive and prophylactic lamivudine therapies, were retrospectively assessed. Liver function tests, hepatitis B virus (HBV) serologic markers, and HBV DNA levels of the patients during follow-up were obtained from hospital file records. Eleven patients (six male) with median age 47 years (range 27-73), median disease duration 50 months (range 9-178) and median follow-up period of patients 13.8 months (range 5-27) were enrolled in this study. Lamivudine therapy was started 3-7 days prior to immunosuppressive therapy in all patients. Baseline, liver function tests were elevated in two patients (fourth patient: ALT:122 IU/l, AST:111 IU/l, tenth patient:ALT:294 IU/l, AST:274 IU/l, with minimal changes in the liver biopsy in both). Shortly after treatment their tests normalized and during follow-up period none of the patients had abnormal liver function tests. In four patients HBV DNA levels were higher than normal at baseline. Two of these normalized and the others increased later. In three additional patients, HBV DNA levels were increased during follow-up. None of the patients had significant clinical sings of HBV activation. Lamivudine was well tolerated and was continued in all patients. Prophylactic administration of lamivudine in patients who required immunosuppressive therapy seems to be safe, well tolerated and effective in preventing HBV reactivation.

Postoperative non-adhesive mechanical intestinal obstruction: a review of seven cases.

BACKGROUND: Postoperative mechanical intestinal obstruction results commonly from adhesions and less often from other pathologies. Establishing the cause of obstruction in the latter category is usually delayed as attention is often focused on the former. Delayed diagnosis and expedient surgical treatment may lead to bowel infarction. METHODOLOGY: Consecutive patients presenting with features of postoperative mechanical intestinal obstruction seen at Jos University Teaching Hospital over a 2 year period between February 2000 and December 2002 were the subject of the study. RESULTS: Seven (20.6 percent) of 34 patients presenting with postoperative mechanical bowel obstruction had pathologies other than adhesions as the underlying cause of obstruction. There were three females and four males with age ranging from 17 to 45 years. All patients presented with features consistent with bowel obstruction. There were no features at the initial setting to suggest non-adhesions as the underlying cause of obstruction. However, three patients had clues that suggested non-adhesions were responsible for the postoperative obstruction. These patients had diagnoses of recurrent sigmoid volvulus, anastomotic colon cancer and a large bowel cancer. They had early surgery and definitive treatment. CONCLUSION: Non-adhesive postoperative mechanical bowel obstruction is a rare life-threatening surgical emergency. A high index of suspicion based on the patient's history and response to conservative management is required to achieve early diagnosis so that surgical treatment can be rapidly instituted.

Pattern of duplex doppler ultrasound scans in Jos University Teaching Hospital.

INTRODUCTION: Doppler ultrasound scan is a non invasive diagnostic tool used in the evaluation of vascular and perivascular lesions. It is gaining a wider acceptance over other methods of vascular evaluation which are expensive and invasive. We aimed at evaluating the indications and findings of duplex doppler ultrasound scans performed in this centre. METHODOLOGY: This was a retrospective study of all consecutive patients that had doppler ultrasound scans from January 2000 to December 2004. RESULTS: One Hundred and sixty five (165) Doppler ultra sound scans were performed on 115 patients. Thirty nine patients had a double scan while 19 had repeated scans. The study population was aged between 2-90 years with a mean age of 44.5 +/- 17.5 years. There were 86 (52.1%) males and 79 (47.9%) females giving a male to female ratio of 1:1.67 (41%) of the doppler scans were for deep vein thrombosis while peripheral vascular disease and vascular aneurysm accounted for 24 (14.5%) and 23 (13.9%) respectively, see Table 1. Reduction in vascular blood flow was the most common doppler finding seen in 34 (20.6%) patients followed by visible thrombi in 14 (8.5%) patients. CONCLUSION: Deep vein thrombosis is the most common indication for doppler ultrasound scan in our practice.

Breast tuberculosis: a case report.

Primary tuberculosis of the breast unlike carcinoma is rare, but secondary lesions from cervical and axillary tuberculous lymphadenitis are not uncommon. In this case, a 60-year-old woman presented with ulcerated axillary lymph node swelling and breast lump. Biopsy of the breast lump and lymph node confirmed tuberculous granuloma. She was commenced on anti-tuberculous chemotherapy and wound dressing. Her wounds and sinuses healed satisfactorily before being discharged to continue her treatment at home. She was however lost to followup.