Prevalence of central obesity in Nigeria: a systematic review and meta-analysis.

OBJECTIVES: Elevated waist circumference results from an excessive accumulation of visceral fat, causing an impairment of health. Waist circumference is highly correlated with diabetes, cardiovascular disease, and all-cause mortality. This study aimed to estimate the overall, sex-specific, and region-specific prevalence rates of central obesity in Nigeria. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Online searches of Google Scholar, PubMed, and Scopus were conducted, and studies were selected based on predefined criteria. Random effects model was fitted using inverse variance method with correction using Sidik-Jonkman's estimator. RESULTS: Eighteen studies consisting of 21,859 individuals conducted between 1996 and 2021 were included in the meta-analysis. Thirty-nine percent (95% confidence interval [CI]: 25%-54%, I2 = 99.3%) of adult Nigerians are centrally obese (by International Diabetes Federation criteria). This translates to estimated 46.8 million centrally obese adult Nigerians. More than half (54% [95% CI: 39%-68%]) of adult females are centrally obese. This is four times the prevalence in males (13% [95% CI: 5%-24%]). Southern regions have higher prevalence of central obesity than northern regions (48% vs 18%). The overall mean waist circumference in Nigeria is 83.8 cm (95% CI: 80.8-86.8 cm, I2 = 99.8%, P value is <0.001). CONCLUSIONS: Females, urban residents, and individuals living in the northern part of Nigeria have a high burden of central obesity. Public health measures for halting the epidemic of obesity should be targeted at these high-risk groups.

Knowledge, attitudes, and perceptions related to telemedicine among young doctors and nursing staff at the King Abdul-Aziz University Hospital Jeddah, KSA.

OBJECTIVE: To investigate the knowledge, perceptions, and attitude of young doctors and nurses at Kind Abdulaziz University Hospital (KAUH) Jeddah, KSA, regarding the effectiveness of telemedicine in dealing with the patients for either follow-up or continuous monitoring of chronic diseases. MATERIAL AND METHODS: This prospective cross-sectional study was carried out on the young doctors and nursing staff at KAUH. An online questionnaire addressing all the required fields, i.e., background essential demography, perceptions, acceptance, and knowledge regarding telemedicine's utility, was sent to the targeted population of health care workers. Completed responses were analyzed statistically as per study objectives. RESULTS: The response rate in our study was 85%. A total of 335 participants responded to our questionnaire. One hundred seventy-one (51.1%) were doctors, whereas one hundred sixty-four (48.9%) were the nursing staff. Among doctors, 50 (29.4%) were recent graduates, whereas, in the nursing side, 77 (46.7%) were the senior nursing students. The knowledge and attitude of the young nursing staff were relatively better than the senior staff taking part in the study and the trends were found statistically significant. CONCLUSION: Our study participants, being young, were enthusiastic, had good knowledge regarding the advantages and limitations of telemedicine in managing the selected groups of patients. Their perception and attitude were quite positive. This is an encouraging trend in the promotion of telemedicine as an established way of managing patients with special requirements in an effective way. The ongoing COVID-19 pandemic has highlighted the importance of telemedicine in emergencies to protect both patients and health care workers by reducing chronic patients' avoidable hospital visits.

Pharyngeal reconstruction with a modified free alt flap with parastomal fascial wings.

AIM: Previous reports have demonstrated good outcomes with the use of the Anterolateral Thigh Flap (ALT) in pharyngeal reconstruction. We report a new modification of free ALT flap pharyngeal reconstruction utilizing vascularised fascial wings or extensions placed in the parastomal gutters to cover the major neck vessels. PATIENTS AND METHODS: This was a single-center retrospective case review. Between November 2017 and January 2019, 8 patients (6 male, 2 female mean age 61, range 35 to 74) underwent near circumferential pharyngeal reconstruction by the modified technique. 3 patients had laryngopharyngectomy for radiorecurrent larynx SCC, 2 for primary, advanced laryngeal SCC, and 3 for primary hypopharyngeal SCC. RESULTS: All eight patients regained adequate swallow to maintain nutrition without tube-feeding. Two of the patients have been assessed as appropriate for tracheo-esophageal puncture and are awaiting placement. One patient uses an electrolarynx for speech and 5 patients aphonic only. One patient died 2 months after the procedure from chest infection. There were no flap failures, no fistulas and no strictures at one year. One patient who underwent a salvage laryngopharyngectomy experienced parastomal wound dehiscence, but critically there was no return to theater for exposed major vessels and the wound healed within 6 weeks requiring dressings only. CONCLUSION: Here we report outcomes of pharyngeal reconstruction with a modified single perforator free ALT flap using fascial extensions to line the parastomal gutters. In the event of parastomal dehiscence, the placement of vascularized tissue parastomally may facilitate spontaneous healing and prevent major vessel exposure.

Deferral patterns of voluntary blood donors at the National Blood Transfusion Service, North East Zonal Centre, Maiduguri.

Appropriate donor selection in an important step in ensuring safe supply of blood and blood products. In this study deferral patterns of voluntary non-renumerated blood donors were determined at the North-Eastern Zonal Centre of the National Blood Transfusion service. The study was conducted between April 2007 and April 2009, and it involved the administration of a structured questionnaire. A total of 4032 voluntary blood donors were recruited, seven hundred and thirteen (17.7%) were temporarily deferred. The commonest reasons for deferral were low haemoglobin, self-deferral, high blood pressure, low weight and high risk behaviour. Other reasons are use of certain medications, low blood pressure and failed venopuncture. Gender analysis showed that more females were deferred for low haemoglobin and more males were self-deferred. Following donor recall, 146 of the 173 donors temporarily deferred came back to donate. These consisted of 113 deferral due to low haemoglobin, 30 self-deferred and 3 induced in risky behaviour. Effective education or counseling, the old tradition of giving haematinics and good dietary advice to those with low haemaglobin values, improved the safety and availability of blood and blood products. Donors who are self-deferred and those involved in high risk bahviour should never be persuaded to donate blood. There is also the need for a review of operational guidelines with regards the uniform acceptable cutoff point of 12.5g/dl haemoglobin value for males and females.

Determination of a safe INR for joint injections in patients taking warfarin.

INTRODUCTION: With an increase in life expectancy in 'developed' countries, the number of elderly patients receiving joint injections for arthritis is increasing. There are legitimate concerns about an increased risk of thromboembolism if anticoagulation is stopped or reversed for such an injection. Despite being a common dilemma, the literature on this issue is scarce. METHODS: We undertook 2,084 joint injections of the knee and shoulder in 1,714 patients between August 2008 and December 2013. Within this cohort, we noted 41 patients who were taking warfarin and followed them immediately after joint injection in the clinic or radiology department, looking carefully for complications. Then, we sought clinical follow-up, correspondence, and imaging evidence for 4 weeks, looking for complications from these joint injections. We recorded International Normalised Ratio (INR) values before injection. RESULTS: No complications were associated with the procedure after any joint injection. The radiologists who undertook ultrasound-guided injections to shoulders re-scanned the joints looking for haemarthroses: they found none. A similar outcome was noted clinically after injections in the outpatient setting. CONCLUSION: With a mean INR of 2.77 (range, 1.7-5.5) and a maximum INR within this group of 5.5, joint injections to the shoulder and knee can be undertaken safely in primary or secondary care settings despite the patient taking warfarin.

Increased dietary oxalate does not increase urinary calcium oxalate saturation in hypercalciuric rats.

BACKGROUND: Human calcium oxalate (CaOx) nephrolithiasis may occur if urine is supersaturated with respect to the solid-phase CaOx. In these patients, dietary oxalate is often restricted to reduce its absorption and subsequent excretion in an effort to lower supersaturation and to decrease stone formation. However, dietary oxalate also binds intestinal calcium which lowers calcium absorption and excretion. The effect of increasing dietary oxalate on urinary CaOx supersaturation is difficult to predict. METHODS: To determine the effect of dietary oxalate intake on urinary supersaturation with respect to CaOx and brushite (CaHPO4), we fed 36th and 37th generation genetic hypercalciuric rats a normal Ca diet (1.2% Ca) alone or with sodium oxalate added at 0.5%, 1.0%, or 2.0% for a total of 18 weeks. We measured urinary ion excretion and calculated supersaturation with respect to the CaOx and CaHPO4 solid phases and determined the type of stones formed. RESULTS: Increasing dietary oxalate from 0% to 2.0% significantly increased urinary oxalate and decreased urinary calcium excretion, the latter presumably due to increased dietary oxalate-binding intestinal calcium. Increasing dietary oxalate from 0% to 2.0% decreased CaOx supersaturation due to the decrease in urinary calcium offsetting the increase in urinary oxalate and the decreased CaHPO4 supersaturation. Each rat in each group formed stones. Scanning electron microscopy revealed discrete stones and not nephrocalcinosis. X-ray and electron diffraction and x-ray microanalysis revealed that the stones were composed of calcium and phosphate; there were no CaOx stones. CONCLUSION: Thus, increasing dietary oxalate led to a decrease in CaOx and CaHPO4 supersaturation and did not alter the universal stone formation found in these rats, nor the type of stones formed. These results suggest the necessity for human studies aimed at determining the role, if any, of limiting oxalate intake to prevent recurrence of CaOx nephrolithiasis.