Integrative Care of the Older Persons in Nigeria: An Appraisal of the Geriatric Centre, University College Hospital, Ibadan.

BACKGROUND: Geriatric medicine is an emerging subspecialty in Nigeria. The interest in the care of older Nigerians followed the Madrid International Plan of Action on Ageing in April 2002. This led to an increase in research, publications and advocacy culminating in the establishment of the pioneer geriatric centre in Nigeria in 2012. Since then, there has been an increase in capacity building, manpower development and institutionalization of geriatric care in Nigeria. This is an account of the evolution of the Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH). METHODS: We undertook the review of the history, structure and key service elements in the Geriatric Centre, UCH from January 1, 2013, to December 31, 2020. RESULTS: The number of patients rose from 2,559 in the first year to 19,300 by the end of 2020. The initial four multidisciplinary units increased to 12 over the review period. Likewise, the in-patient admission increased between the first year (122 patients) and 2020 (141 patients). The overall mortality rate was 11.4% over the review period. Internship opportunities were provided to students including resident doctors, undergraduates (medical) and postgraduate students (Masters and PhD). Besides, 139 medical doctors have undergone the annual basic certificate training in geriatric medicine organised by the Centre. Also, 7 fellowship dissertations and 11 peer-reviewed papers have been published. CONCLUSION: The centre has demonstrated the possibility of caring for older patients in a low-resource setting. The employment of the multidisciplinary approach yielded a low mortality rate, higher attendance and manpower development.

CONTEXTE: La médecine gériatrique est une sous-spécialité émergente au Nigéria. L'intérêt pour les soins aux Nigérians âgés a suivi le Plan d'action international de Madrid sur le vieillissement en avril 2002. Cela a conduit à une augmentation de la recherche, des publications et du plaidoyer aboutissant à la création du centre gériatrique pionnier au Nigéria en 2012. Depuis lors, il y a eu Il y a eu une augmentation du renforcement des capacités, du développement de la main-d'œuvre et de l'institutionnalisation des soins gériatriques au Nigeria. Ceci est un compte rendu de l'évolution du Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH). MÉTHODES: Nous avons entrepris l'examen de l'historique, de la structure et des éléments de service clés du Centre gériatrique, UCH du 1er janvier 2013 au 31 décembre 2020. RÉSULTATS: Le nombre de patients est passé de 2 559 la première année à 19 300 fin 2020. Les quatre unités multidisciplinaires initiales sont passées à 12 au cours de la période d'examen. De même, l'hospitalisation a augmenté entre la première année (122 patients) et 2020 (141 patients). Le taux de mortalité global était de 11,4 % au cours de la période d'examen. Des opportunités de stages ont été offertes aux étudiants, notamment aux médecins résidents, aux étudiants de premier cycle (médecine) et aux étudiants de troisième cycle (maîtrise et doctorat). Par ailleurs, 139 médecins ont suivi la formation annuelle certifiante de base en médecine gériatrique organisée par le Centre. En outre, 7 thèses de bourses et 11 articles évalués par des pairs ont été publiés. CONCLUSION: Le centre a démontré la possibilité de prendre en charge des patients âgés dans un milieu à faibles ressources. L'emploi de l'approche multidisciplinaire a donné un faible taux de mortalité, une fréquentation plus élevée et un développement de la main-d'œuvre. Mots-clés: Soins intégratifs, personnes âgées, Centre gériatrique, Ibadan, Nigéria.

Prevalence and Correlates of Frailty Syndrome among Older Adults Attending Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan.

BACKGROUND: Frailty has emerged as an important clinical measurement among older adults because of its negative health outcomes. OBJECTIVE: This study measured the prevalence and factors associated with frailty among older adults aged 60 years and above at a Geriatric Centre in Nigeria. METHODS: In this descriptive cross-sectional study, 971 older adults were recruited consecutively. Data on sociodemographics characteristics and clinical parameters were obtained using an interviewer-administered questionnaire and physical examination performed. The Frailty syndrome and Frailty Index were assessed using the Fried Frailty Criteria (FFC) and Canadian Study of Health and Aging (CSHA) scale respectively. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05. RESULTS: The mean age of the participants was 71.3 (± 7.1) years with a female to male ratio of 2.4:1. Based on FFC scale, 498 older persons (51.3%) had frailty syndrome while only 148 (15.2%) were frail using the CSHA scale. The measure of agreement (Kappa statistics) was 0.22 (p<0001) indicating weak agreement between the two scales. Logistic regression analysis revealed increasing age (OR=1.948 [1.219-3.113]), multiple morbidities (OR= 1.584, [1.177-2.201]), depression (OR= 5.050, [2.501-9.442,]), imbalance or increased risk of fall (OR 1.623, [1.192-2.211,]), and inability to perform IADL (OR= 0.599 [0.535-0.670,]) to be the most significant determinants of frailty syndrome while obesity (OR=0.660, [0.449-0.971]), unusually appeared a deterrent. CONCLUSION: The prevalence of frailty syndrome was high among the older adults. Targeted and timely interventions on the modifiable factors may delay progression into frailty and the eventual negative health outcomes.

CONTEXTE: La fragilité a ete emerge comme un élément clinique important mesure chez les personnes âgées en raison de son état de santé négatif les résultats. OBJECTIF: Cette étude a mesuré la prévalence et les facteurs associée à la fragilité chez les personnes âgées de 60 ans et cidessus dans un centre gériatrique au Nigéria. MÉTHODES: Dans cette étude transversale descriptive, 971 des adultes plus âgés ont été recrutés consécutivement. Les données sur les caractéristiques sociodémographiques et les paramètres cliniques ont été obtenu à l'aide d'un questionnaire administré par l'enquêteur et un examen physique effectué. Le syndrome de fragilité et l'indice de fragilité ont été évalués à l'aide du Fried Frailty Critères (FFC) et étude canadienne sur la santé et le vieillissement (CSHA) respectivement. Bivarié et multivarié les analyses ont été réalisées à l'aide de SPSS version 21 à p <0,05. RÉSULTATS: L'âge moyen des participants était de 71,3 (± 7,1) ans avec un ratio femmes / hommes de 2,4: 1. Basé sur l'échelle FFC, 498 personnes âgées (51,3%) avaient un syndrome de fragilité alors que seulement 148 (15,2%) étaient fragiles selon l'échelle de la SCVS. La mesure d'accord (statistiques Kappa) était de 0,22 (p <0001) indiquant faible accord entre les deux échelles. Une analyse de régression logistique a révélé une augmentation de l'âge (OR = 1,948 [1,219-3,113]), morbidités multiples (OR = 1,584, [1.177-2.201]), dépression (OR = 5.050, [2.501-9.442,]), déséquilibre ou risque accru de chute (OR 1.623, [1.192-2.211,]), et l'incapacité d'effectuer une IADL (OR = 0,599 [0,535-0,670,]) pour être les déterminants les plus importants du syndrome de fragilité obésité (OR = 0,660, [0,449-0,971]), apparaissait inhabituellement dissuasif. CONCLUSION: La prévalence du syndrome de fragilité était élevée parmi les personnes âgées. Interventions ciblées et opportunes sur les facteurs modifiables peuvent retarder la progression vers la fragilité et les éventuels effets négatifs sur la santé. Mots clés: Syndrome de fragilité; Corrélats; Les adultes plus âgés; Gériatrie.

Mortality Trends among Older Patients Admitted to the Geriatric Centre, University College Hospital, Ibadan, Nigeria, 2013-2017.

BACKGROUND: Attaining successful clinical outcomes in the management of hospitalised older patients in the overburdened healthcare services in Nigeria constitutes a major challenge against the backdrop of dearth of data on the predictors of mortality among them. OBJECTIVES: To describe the mortality trends and associated factors among older patients (>60 years) at the Geriatric Centre, University College Hospital, Ibadan between January 2013 and December 2017. METHODS: Hospital records of older patients admitted were analysed. Data extracted included socio-demographic, diagnoses, length of stay from date of admission to discharge or death. Results of vital signs, anthropometric measurements and laboratory tests carried out at admission were also obtained. RESULTS: The mean age of the 1,091 older patients admitted was 73.6±8.6 years. The overall crude proportion of in-hospital deaths was 9.0% (males=11.3% > females=7.2%, p=0.024) and it increased from 4.1% in 2013 to 12.1% in 2017. The overall unadjusted 30-day mortality rate per 1000 patient-days was 28.9 deaths (95% CI 23.5-35.3). The predictors of mortality were increased length of stay on admission OR=1.061 (95% CI 1.005-1.119), being retired OR=1.672 (95% CI 1.011-2.778), stroke OR=4.019 (95% CI 2.258- 7.138), heart failure OR=3.435 (95% CI 1.455-8.100), Sepsis OR=2.176 (95% CI 1.294-3.654), Anaemia OR=2.820 (95% CI 1.320-6.017), Dementia OR=3.701 (95% CI 1.433-9.549) and malignancies OR=2.658 (95% CI 1.181-5.979). CONCLUSION: There was a temporal increase in mortality among older patients. Similarly, staying longer on admission and chronic medical conditions with their complications were the most significant contributors to mortality.

Factors associated with sarcopenia among older patients attending a geriatric clinic in Nigeria.

CONTEXT: Aging is characterized by progressive and generalized loss of skeletal muscle mass and strength called sarcopenia which causes poor health and disability. There is paucity of data on this syndrome of public health importance among older Nigerians. AIM: This study determined the prevalence and factors associated with sarcopenia among persons aged 60 years and above at a geriatric center in Nigeria. MATERIALS AND METHODS: A cross-sectional study of 642 persons aged ≥60 years who attended the geriatric center between March and July 2014. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People criteria. Bivariate and multivariate analyses were carried out using SPSS 20. Alpha was set at 0.05. RESULTS: The mean age ± standard deviation of the respondents was 69.1 ± 7.2 years, and 378 (60.6%) were females. The point prevalence of sarcopenia was 5.4% which was significantly higher among the females compared with the males (7.1% vs. 2.8%) P = 0.02. Low muscle mass and low gait speed were found in 10.9% and 36.1%, respectively. Logistic regression analysis showed age (odds ratio [OR] =1.090; 95% confidence interval [CI] =1.034-1.149, P = 0.01), having no formal education (OR = 2.810; 95% CI = 1.043-7.573, P = 0.04), malnutrition (OR = 5.817; 95% CI = 1.471-23.434, P = 0.01), and female gender (OR = 3.068; 95% CI = 1.068-8.817, P = 0.04) to be the predictors of sarcopenia. CONCLUSION: Older people in this setting are at risk of developing sarcopenia, especially the females. Healthcare workers should address the social and health-related factors which could lead to sarcopenia.

Morphometric study of lumbar vertebrae in adult South African subjects / Estudio morfométrico de las vértebras lumbares en sujetos adultos de Sudáfrica

Lumbar vertebral dimensions provide vital clinical information of immense diagnostic benefits to medical experts. The present study provides data for lumbar vertebral dimensions of a cohort of specimens of South African females and males. Measurements were obtained from lumbar vertebrae from the osteological collections in the Discipline of Clinical Anatomy, Nelson Mandela School of Medicine using a digital caliper. The antero-posterior body diameter (APD), interpedicular distance (IPD), midsagittal diameter (MSD) and pedicle length (PL) were measured while ratio of MSD to APD was calculated. Results showed gradual increase from L1 to L5 for mean APD and IPD, and a decrease for mean PL from L1 to L5. Mean MSD was observed to present a "U" curve pattern from L1 to L5, while MSD/APD ratio decreased from L2 downwards. We report that certain lumbar dimensions also showed significant correlation with age at distinct lumbar levels. The present data provides a baseline of lumbar vertebral morphology for the South African adult cohort and requires further investigations with larger cohort.

Las dimensiones lumbares vertebrales proporcionan información vital en la clínica para alcanzar un diagnóstico correcto. El presente estudio proporciona datos de las dimensiones vertebrales lumbares en una cohorte de hombres y mujeres de Sudáfrica. Las mediciones de las vértebras lumbares se obtuvieron de colecciones osteológicas correspondientes a la Cátedra de Anatomía Clínica, de la Escuela de Medicina Nelson Mandela. Se utilizó un calibrador digital. Se midieron el diámetro antero-posterior del cuerpo vertebral (DPA), la distancia interpedicular (DIP), el diámetro sagital mediano (DSM) y la longitud del pedículo (LP); y se calculó la relación de DSM con DPA. Los resultados mostraron un aumento gradual de L1 a L5 para la mediana de DPA y DIP, y una disminución de la media de LP de L1 a L5. La media de DSM presentó un patrón de curva en "U" de L1 a L5, mientras que el índice DSM / DPA disminuyó de L2 hacia inferior. Ciertas dimensiones lumbares también mostraron una correlación significativa con la edad en los distintos niveles lumbares. El presente estudio proporciona datos acerca de la morfología vertebral lumbar para una cohorte de adultos de Sudáfrica, y consideramos que se requieren de más investigaciones con una cohorte más amplia.

Comparison of antioxidant effects of kolaviron and vitamin C interventions on testicular structures following nevirapine administration in Sprague-Dawley rats / Comparación de los efectos antioxidantes en la intervención con kolaviron y vitamina C sobre las estructuras testiculares después de la administración de nevirapina en ratas Sprague-Dawley

Testicular toxicity has been implicated in highly active anti-retroviral therapy (HAART) treatment. Hence there is need to identify an effective antioxidant product that can alleviate testicular necrosis due to HAART administration. Forty eight adult male Sprague-Dawley rats were used in this study. The animals were divided into eight (8) groups: A-H (n= 6). Group A animals received normal saline as the control; Group B was given Nevirapine (Nv); Group C was given Kolaviron (Kv); Group D was given vitamin C; Group E was given Nv and Kv; Group F was given Nv and Vitamin C; Group G was given Nv for 56 d and Kv for 28 d serving as a withdrawal group; Group H was given corn oil. Nv, Kv and Vit. C were given at 1.54, 200 and 250 (mg·kg)/bw respectively while all administrations were through oral gavage. The body weights were taken every other day. Thereafter, they were anaesthetized with halothane. The testes were excised, weighed, fixed in Bouin's fluid and stained with H&E while the epididymes removed for semen fluid analyses. The results showed a significant (P<0.05) decrease in sperm motility in group E (Nevirapine + kolaviron) when compared with group F (Nevirapine + Vitamin C) while Sperm count was not significantly different (P>0.05) across the groups. The testicular histoarchitectural studies revealed indistinct spermatogonia, necrotic interstititial endocrine cells in the altered interstitial space, fragmented spermatids, atrophy of mature spermatocytes, degenerated germ cells, obliterated seminiferous tubules lumen, undifferentiated spermatogonia and cellular debris in the somniferous tubules lumen of nevirapine administered group but normal across the other groups. In the testis, there were no significant reduction in SOD, Catalase and GPx activities but a significant decrease in GST activity (P<0.001) when group E was compared with group F. In conclusion, vitamin C presents a better remediation in nevirapine induced spermiotoxicity compared to kolaviron in Sprague-Dawley rats.

La toxicidad testicular ha sido implicada en la terapia antirretroviral altamente activa (TARAA). Por lo tanto existe la necesidad de identificar un producto antioxidante eficaz que pueda aliviar la necrosis testicular en la administración de la TARAA. Cuarenta y ocho ratas macho Sprague-Dawley adultas fueron utilizadas. Los animales se dividieron en ocho (8) grupos: AH (n= 6). Grupo A, animales recibieron solución salina normal como el control; Grupo B, recibió Nevirapina (Nv); Grupo C, recibió Kolaviron (Kv); Grupo D, recibió vitamina C; Grupo E, recibió Nv y Kv; Grupo F, recibió Nv y vitamina C; Grupo G, recibió Nv durante 56 d y Kv por 28 d como un grupo de retirada; Grupo H, recibió aceite de maíz. Nv, Kv y Vit. C se administraron en dosis de 1, 54, 200 y 250 (mg · kg) de peso corporal respectivamente; todas las administraciones fueron por sonda oral. Los pesos corporales se tomaron cada dos días. A partir de ese momento los animales fueron anestesiados con halotano. Los testículos fueron extirpados, pesados y fijados en solución de Bouin y teñidos con H&E, mientras que el epidídimo se retiró para analizar el semen. Los resultados mostraron un descenso (p<0,05) en la motilidad de los espermatozoides en el grupo E (Nevirapina + Kolaviron) en comparación con el grupo F (Nevirapina + vitamina C), mientras que el recuento espermático no mostró diferencias significativas (P>0,05) entre los grupos. El estudio de la histoarquitectura testicular reveló espermatogonias indiferenciadas, con células intersticiales necróticas en el espacio intersticial y espermátidas fragmentadas. Además, en el grupo que recibió Nevirapina mostró espermatocitos maduros atrofiados, degeneración de células germinales, lumen de los túbulos seminíferos obliterados, espermatogonias indiferenciadas y restos celulares en el lumen de los tubulos seminíferos. En el resto de los grupos los resultados fueron normales. En el testículo hubo una reducción significativa en las actividades de la superóxido dismutasa, catalasa y glutatión peroxidasa, pero una disminución significativa en la actividad glutatión S-transferasa (P <0,001) al comparar los grupo E y F.

Comparative evaluation of biogas production from poultry droppings, cow dung and lemon grass.

The study explored the production of biogas from Lemon grass, Cow dung and Poultry droppings. The three substrates were pre-fermented according to standard methods. Six (6) kg of each pre-fermented substrate was mixed with water in ratio 1:1 v/v to form slurry and digested for 30days. A total of 0.125m(3), 0.191m(3) and 0.211m(3) of biogas were respectively produced from the Lemon grass, Cow dung and Poultry droppings with deviations of 0.00234m(3), 0.00289 m(3) and 0.00484 m(3) respectively. The cooking test carried out revealed that the scrubbed gas had higher cooking rates for water (0.12L/min, 0.085L/min and 0.079L/min for Lemon grass, Cow dung and Poultry droppings respectively) while the cooking rates for unscrubbed gas were 0.079L/min, 0.064L/min and 0.06L/min respectively. The pH of the medium fluctuated optimally between 6.5 and 7.8. The research demonstrated that Lemon grass produced less volume but better quality biogas compared to Cow dung and Poultry droppings.

Microarchitectural adaptations in the stomach of African tree pangolin (Manis tricuspis) / Adaptaciones microarquitecturales en el estómago del pangolin africano (Manis tricuspis)

The microarchitecture of the pangolin's stomach favouring the high chitinous diet has been less waived into, despite extensive morphological investigations. Histological analysis of the microanatomy will provide powerful tools for interpretation to yield reliable insights. We investigated this by fixing the tissues in 10 percent formol saline for histological analysis. Serial sections at 5 micron m thickness were subjected to general staining methods for light microscopic study (Haematoxylin and eosin, Van Gieson's and Verhoeff's). The results revealed basic structural arrangements in their coats, with a modification of the epithelial lining of cardia and fundus into stratified squamous keratinized epithelium. These modifications were also reflected in the distribution of collagen and elastic fibers in the various layers (coats) of the stomach. The present study has shown that there was an adaptation of the stomach of African tree pangolin to its diet as reflected in the microarchitectural configuration.

La micro arquitectura del estómago de los pangolines que favorece la alta dieta de chitinous sido poco tomada en cuenta, a pesar de las amplias investigaciones morfológicas. El análisis histológico de la microanatomía proporcionará herramientas de gran importancia para la interpretación, junto con dar una información confiable. Se investigó mediante la fijación de los tejidos en solución salina de formol al 10 por ciento para análisis histológico. Las serie de secciones fueron sometidos a métodos de tinción estándar para el estudio con microscopía de luz (hematoxilina y eosina, Van Gieson y Verhoeff s). Los resultados revelaron adaptaciones estructurales básicas en sus capas, con una modificación del revestimiento epitelial del cardias y fundus en epitelio escamoso estratificado (queratinizado). Estas modificaciones también se reflejan en la distribución de colágeno y fibras elásticas en las diversas capas del estómago. El presente estudio ha demostrado que es una adaptación del estómago a la dieta como se refleja en la configuración de la microarquitectura.

A comparative study of the ileum in rat (Rattus norvegicus), Bat (Eidolon helvum) and Pangolin (Manis tricuspis) as investigated using histological method / Estudio comparativo del íleon en rata (Rattus norvegicus), murciélago (Eidolon helvum) y pangolín (Manis tricuspis) utilizando como investigación el método histológico

The histological and morphometric differences in some parts of the gastrointestinal tracts of rat, bat and pangolin have been well established. This investigation aims at comparatively elucidating any adaptational changes the ileum of the three mammals must have adopted to meet its dietary requirements and also cope with their morphological differences. The investigation was carried out using ten rats, ten bats and ten pangolins of both sexes. The animals were slightly anaesthetized under chloroform inhalation. The intestines were harvested and the ileum excised and fixed in 10 percent formol saline. The tissues were processed for light microscopic study. The following stains were employed: Haematoxylin and eosin (H & E), Van Gieson and Verhoeff's haematoxylin elastic tissue stain. Stained slides were also analysed morphometrically. The results revealed microstructural modifications which characterized the mucosa as well as the pattern of distribution of the conjuntive tissue fibers in the ileum of the three mammals. These modifications are means of successfully coping with their respective diets and morphological differences.

Las diferencias histológicas y morfométricas en algunas partes del tubo digestivo de ratas, murciélagos y pangolines han sido bien establecidos. Esta investigación tiene por objeto aclarar comparativamente cualquier cambio de adaptación del íleon de los tres mamíferos que hayan adoptado para satisfacer sus necesidades dietéticas y también hacer frente a sus diferencias morfológicas. La investigación se llevó a cabo usando 10 ratas, 10 murciélagos y 10 pangolines, de ambos sexos. Los animales fueron ligeramente anestesiados bajo inhalación de cloroformo. Los intestinos fueron expuestos, el íleon extirpado y fijado en formol salino al 10 por ciento. Los tejidos fueron procesados para su estudio por microscopía de luz. Los siguientes tinciones fueron empleadas: Hematoxilina y eosina (H & E), Van Gieson y tinción de hematoxilina para tejidos elásticos de Verhoeff. Los cortes teñidos también se analizaron morfométricamente. Los resultados revelaron modificaciones microestructurales características de la mucosa, así como el patrón de distribución de las fibras de tejido conjuntivo en el íleon de los tres mamíferos. Estas modificaciones son el medio para entender sus diferencias en la dieta y morfología respectivamente.

Prevalence of Anaplasma marginale, Babesia bigemina and B. bovis in Nigerian cattle using serological methods.

Serum samples collected randomly from 500 cattle from the 10 northern states of Nigeria were tested for antibodies against Anaplasma marginale by indirect fluorescent antibody (IFA), card agglutination (CT) and capillary tube-agglutination (CA) tests. The serum samples were also examined for antibodies to Babesia bigemina and B. bovis by the IFA test only. Of the serum samples tested, 79.4% had antibodies against A. marginale by the IFA test, 40 and 25% in the CT and CA tests, respectively. The IFA test results for B. bigemina and B. bovis were 29.4 and 14.1%, respectively.

Experimental bovine anaplasmosis: clinico-pathological and nutritional studies.

Groups of Brahman-cross steers maintained on two nutritional planes were infected intravenously with a stabilate of Anaplasma marginale. In general, animals on the higher plane of nutrition were more severely affected. Fever was the first clinical sign of anaplasmosis but, like anaemia, was absent in the mildest cases. When present anaemia appeared two to three weeks after infection. There was a corresponding increase in erythrocyte sedimentation rates when read after 24 h but not at 1 h. The haemolytic nature of the anaemia was indicated by a significant increase in unconjugated bilirubin during the acute phase. Some visceral damage was suggested by a significant increase of serum aspartate amino-transferase (GOT) especially in severely affected animals of the 'high' nutrition group but no significant change occurred in levels of alanine amino-transferase (GPT).