PRELIMINARY REPORT ON THE USE OF NUTRACEUTICALS IN THE MANAGEMENT OF SICKLE CELL ANEMIA: A CASE SERIES.

Background: There is growing recognition of the benefits of nutraceuticals in the management of sickle cell disease but a scarcity of reports on their use. Nutraceuticals are food or parts of food that provide medical or health benefits. They include botanicals, functional foods and medicinal foods. This is a preliminary report on the use of nutraceuticals in the management of a small cohort of children with sickle cell disease in Nigeria. Patients and Methods: The retrospective audit of clinical outcomes was carried out at a brain center located within the Federal Capital Territory, Abuja, Nigeria. Children, aged 1 to 12 years, presenting with sickle cell anaemia were evaluated at baseline and at six months after the commencement of a cocktail of nutraceuticals using an objective grading tool. Changes in weight, haematocrit and frequency of sickle cell crises were determined. On account of the small sample size, Wilcoxon sign test was used to determine the similarity / difference between the average values of weight, PCV, and crises obtained at enro7lment and six months. Results: Ten children with sickle cell anaemia were placed on nutraceuticals therapy. The average age of the children was 8.5 (range 1 - 12) years. Aroga immune support was the commonest component of the nutraceutical cocktail given to the children. There was a rise in average weight (from 21.8 to 23.0 Kg, p-value 0.236) and average haematocrit (22.8 to 27.2, p-value 0.011) at six months compared to values obtained at baseline. There was also a fall in the average frequency of sickle cell crises at six months compared to values obtained at baseline (from 7.4 to 3.2, p-value 0.011). Overall, eight out of the ten children showed moderate to good clinical improvement. There was no documentation of any adverse reaction to the medications in any of the children. Conclusion: The results suggest that the use of nutraceuticals may be beneficial in the management of sickle cell anaemia in children. However, the results are preliminary and will require stronger evidence. There is a need for controlled clinical trials for using larger sample sizes. Such clinical trials of unconventional therapies should be conducted with great care and concern for the safety of the participants.

How secured and safe is the sanitation and hygiene services in a maximum-security correctional facility in Southwest Nigeria: a descriptive cross-sectional study.

Poorly maintained living conditions and infrastructure are the banes of Nigerian prisons. The study investigated its environmental conditions and the prevalent diseases among inmates.The descriptive, cross-sectional study enrolled 420-inmates through a multistage sampling technique. Pre-tested instruments were administered and results presented with descriptive and logistic regression to identify predictors of toilet-cleaning and handwashing practices at P∝0.05.The mean(±SD) age and modal inmates/cell were 30±7.2 years and 36. Most inmates were males (97%), await-trial (79%) and lives in overcrowded cells (58%). Sixty-nine percent of free-cells has pour-flush toilets and 36% waits for 2-5 minutes before accessing toilets.Fifty-three percent of inmates clean latrines with water and soap, 71% burn solid waste while handwashing period-prevalence was 36%. Religion, toilet-cleaning, and education were predictors of handwashing while types of toilets and access predict toilet-cleaning behaviour. Malaria (81.1%) and scabies (7.3%) were endemic. The prison rehabilitation shall satisfy basic life needs and promote prisoners' health.

Coronavirus Disease 2019 (COVID-19): Clinical Perspectives and Ongoing Challenges.

BACKGROUND: Emerging infectious diseases pose a great hazard to public health and the global economy. A novel coronavirus, SARS-CoV-2, causing coronavirus disease 2019 (COVID-19), emerged from Wuhan, China, in December 2019. Since then, it has spread globally causing a global health emergency of inconceivable magnitude, with significant morbidity and mortality. There is the need for clinicians and health care providers to understand and gain knowledge of the different aspects of the disease as it evolves. OBJECTIVE: We reviewed existing literature on COVID-19 in order to present a synopsis of current understanding of the disease. METHODS: Using PubMed, Embase and Medline, articles published between January and April 2020 on Coronavirus disease 2019 (COVID-19), and resources from World Health Organisation were analyzed in order to have an understanding of the clinical characteristics, transmission dynamics, virology, diagnostic possibilities, prevention, management approach, controversies and impact of COVID-19 on the healthcare workforce. RESULTS: Our review revealed that COVID-19 patients present with a myriad of symptoms, ranging from mild to severe respiratory disease, which can often be fatal. The mode of transmission via droplet infections makes it unduly contagious and difficult to control. Currently, antiviral drugs or vaccines are being developed to manage this condition. CONCLUSION: There is urgent need for potent antivirals and vaccine to manage those infected with COVID 19 and prevent infection. Global efforts need to be unified in combating this public health emergency and flattening the curve of spread.

Takayasu's Arteritis Presenting Atypically in a Female Nigerian.

Takayasu's arteritis (TA) is an idiopathic form of large vessel granulomatous vasculitis that mainly affects the aorta and its major branches, most frequently in young women under 50 years. While traditionally, it is a disease found commonly in Asia continent, it has also been reported from different parts of the world, albeit with a few reports from Sub-Sahara Africa. The clinical presentations are variable and are commonly from systemic inflammation, vascular occlusive diseases and aneurysm. Asymptomatic cases of TA have been documented and are usually discovered incidentally on physical examination. Common vascular symptoms from different series include vascular claudication, reduced or absent pulse, carotid bruit, hypertension and headache. Facial mononeuropathy and retinal ischaemic changes are rare findings in TA. However, occlusive disease of ulnar artery has not been reported in TA despite our extensive literature search. Here, we present a 48-year-old woman, who was admitted via the medical emergency with community acquired pneumonia but was incidentally diagnosed with Takayasu arteritis with lower motor neuron facial nerve palsy, unilateral blindness, and ulnar artery occlusion. Multidisciplinary management was instituted and patient was discharged after resolution of community acquired pneumonia, vascular claudication, and chronic headache. TA often presents asymptomatically and sometimes with atypical features and thus we suggest high index of suspicion and detailed cardio-vascular examination in young individuals with unexplained chronic headache, facial nerve palsy and visual symptoms.

International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings.

BACKGROUND: Psoriatic arthritis (PsA) is a challenging heterogeneous disease. The European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) last published their respective recommendations for the management of PsA in 2015. However, these guidelines are primarily based on studies conducted in resource replete countries and may not be applicable in countries in the Americas (except Canada and USA) and Africa. We sought to adapt the existing recommendations for these regions under the auspices of the International League of Associations for Rheumatology (ILAR). PROCESS: The ADAPTE Collaboration (2009) process for guideline adaptation was followed to adapt the EULAR and GRAPPA PsA treatment recommendations for the Americas and Africa. The process was conducted in three recommended phases: set-up phase; adaptation phase (defining health questions, assessing source recommendations, drafting report), and finalization phase (external review, aftercare planning, and final production). RESULT: ILAR recommendations have been derived principally by adapting the GRAPPA recommendations, additionally, EULAR recommendations where appropriate and supplemented by expert opinion and literature from these regions. A paucity of data relevant to resource-poor settings was found in PsA management literature. CONCLUSION: The ILAR Treatment Recommendations for PsA intends to serve as reference for the management of PsA in the Americas and Africa. This paper illustrates the experience of an international working group in adapting existing recommendations to a resource-poor setting. It highlights the need to conduct research on the management of PsA in these regions as data are currently lacking.Key Points• The paper presents adapted recommendations for the management of psoriatic arthritis in resource-poor settings.• The ADAPTE process was used to adapt existing GRAPPA and EULAR recommendations by collaboration with practicing clinicians from the Americas and Africa.• The evidence from resource-poor settings to answer clinically relevant questions was scant or non-existent; hence, a research agenda is proposed.

POSSIBLE EFFECTS OF NUTRACEUTICALS IN THE MANAGEMENT OF SOME NEURODEVELOPMENTAL DISORDERS IN NIGERIAN CHILDREN.

INTRODUCTION: A nutraceutical is a pharmaceutical grade nutrient or nutrient complex that may be used for medicinal purposes. Most nutraceuticals are derived from plants and have been shown to be generally safe when used as food supplements. There is growing interest in the use of these natural products in delaying, ameliorating, and treating acute and chronic diseases. Ong W.Y and co-editors in 2016 edited a special collection of reports on beneficial effects of nutraceuticals in the management of neurodegenerative diseases and aging. However, there is paucity of reports of their use in sub- Saharan Africa. CASE REPORTS: Here we describe a case series of some of the children managed at our center using nutraceuticals and other supportive care. Details of the observed effects are described in this report. DISCUSSION: Globally, there is rising evidence of improved treatment outcomes with use of nutraceuticals. Our experience in the management of Nigerian children with neurodevelopmental disorders suggests that they may be beneficial and are deserving of well-controlled studies. We hope that this case series will raise interest of researchers in Nigeria in designing observational studies and clinical trials aimed at generating evidence for or against their use.

Knowledge, attitude and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists in Nigeria.

BACKGROUND: In Nigeria, nurse-anaesthetists are responsible for administering perioperative prophylactic antibiotics in a large number of operations but this practice is poorly studied. AIMS: The aim of this study was to evaluate the knowledge, attitude and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists in Nigeria. METHODS: A cross-sectional study was conducted among nurse-anaesthetists at an Annual General Meeting/Scientific Conference of Nigeria Association of Nurse-Anaesthetists, using a pre-tested questionnaire. RESULTS: Of 70 questionnaires. 67 were returned. Antibiotic administration at induction of anaesthesia was considered inappropriate by 79.1% (n = 67) and safe by 42.6% (n = 61). There was poor knowledge of indications for intraoperative administration. There was agreement by 81.9% of respondents that anaesthetists should administer prophylactic antibiotics (n = 66) but 72.2% would want the surgeon to indicate the time of administration (n = 60). About 69.3% and 77.2% of respondents administered prophylactic antibiotics before tourniquet application (n = 62) and skin incision (n = 66) respectively in their practice but the latter finding was not corroborated by internal validity check. Availability of a hospital perioperative antibiotic prophylaxis protocol (p = 0.048) and practice for 10 or more years (p = 0.009) were associated with higher knowledge score. CONCLUSION: Inclusion of lectures on perioperative antibiotic prophylaxis in nurse-anaesthesia training curriculum, having hospital perioperative antibiotic prophylaxis protocol, stating in the protocols that surgeons give instructions on timing of antibiotic administration and ensuring adherence to the protocols may improve knowledge and practice of perioperative antibiotic prophylaxis among nurse-anaesthetists.

On the use of drains in orthopedic and trauma.

INTRODUCTION: The use of drains in trauma and Orthopaedic practice has been affected by the concept of evidence based medicine that has become accepted as standard of care for all surgical or medical practice, which questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi centre meta-analytical studies that found drains to be of little or no benefit in trauma and Orthopaedic operations. Because of these studies, there are few situations where drains are routinely used e.g. Calcaneal fractures in developed countries. Even major procedures like total knee and arthroplasties are being performed without drains. We set to find out whether such evidence can be found in our practice. MATERIALS AND METHODS: Between 2004 and 2012, eighty six patients matched for sex and type of injury and operative procedures to be done were prospectively selected and assigned to use or no use of drains in their operations. Complications like haematoma, drain migration, infection, inadvertent drain stitching were observed in the two groups. RESULTS: Eighty six major orthopaedic operations were studied. There was no evidence of occurrence of complication arising from non use of drains in the undrained group. Those patients whose wounds were drained had no need for drain change thus making the wound care less eventful CONCLUSION: Postoperative wound drains make for neat postoperative period with less tissue swelling. There was no statistically significant differences between the drained and undrained wounds in terms of infection rates, haematoma or seroma formation.

Indications and complications of major limb amputations in Kano, Nigeria.

OBJECTIVES: To determine the indications and complications of major limb amputations in a Nigerian hospital. DESIGN: A five-year retrospective descriptive study. SETTING: National Orthopaedic Hospital, Dala, Kano, Nigeria. PARTICIPANTS: Patients who had amputations above the wrist or ankle between January 2006 and December 2010. MAIN OUTCOME MEASURES: Indications, complications and mortality. RESULTS: There were 132 unilateral amputations. The patients were mostly males and below the age of 40. Lower limb amputations (74.2%) exceeded upper limb amputations (25.8%). The commonest indication was trauma (42.4%) followed by TBS gangrene (31.8%) and malignant tumours (12.9%). Wound infection, the commonest complication, occurred in patients who had identifiable predisposing factors. The 3 deaths that occurred were in patients who had had traditional bone setter intervention: 2 were due to septicaemia; 1, due to severe tetanus. CONCLUSION: Trauma and traditional bone setter gangrene were the commonest indications. Most of the amputations were avoidable. Institution of preventive measures is imperative. Paying attention to predisposing factors can reduce complications.

Fixation of ankle arthrodesis in a national orthopaedic hospital in Nigeria.

BACKGROUND: Internal fixation is currently preferred for ankle arthrodesis. There are, however, situations in which external fixation is a safer choice. This is a five-year retrospective study of ankle arthrodesis to assess the choice, technique and outcome of fixation methods used. METHODS: Case notes and radiographs of patients with complete records who had ankle arthrodesis between January 1st, 2004 and December 31st 2008 were reviewed. RESULTS: Twenty ankle arthrodeses in 20 patients were reviewed. External fixation, commonly with Charnley's device, was used in 95% of the arthrodeses. Initial alignment was lost in 62.5% of arthrodeses with Charnley's device without immediate short leg cast support. One tibiotalar arthrodesis done with a single screw had subtalarjoint penetration. Fusion and complication rates were 90% and 45% respectively. Foot and ankle oedema and pin-tract infection were the commonest complications. CONCLUSION: External fixation was more commonly used than internal fixation because most of the patients had altered bone anatomy, wounds, active infection, or osteopenia. Charnley's device was the most commonly used external fixator and incorporating it in a short leg cast immediately after operation might improve its rotatory stability. The use of image intensifier is recommended for the placement of two crossed tibiotalar screws to avoid subtalar penetration.

Adult large bowel obstruction: a review of clinical experience.

BACKGROUND: Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. MATERIALS AND METHODS: This is a prospective study of adult patients with acute large bowel obstruction over a 6-year period. The diagnosis of adult obstruction was made from a history of constipation, abdominal distension, abdominal pain, nausea, and radiographic features of large bowel obstruction. Laparotomy was performed on all patients after resuscitation. If the obstruction involved the right colon resection and primary ileo-colic anastomosis was performed, while for a lesion in the left colon a resection and primary colocolic anastomosis was performed after intraoperative antegrade colonic irrigation. If the obstructing lesions were thought to be malignant and too advanced to merit any excisional or the patient's general condition was too poor to withstand resection, a biopsy was taken and a decompressive bypass procedure given pending the confirmation of the diagnosis. The clinical course and postoperative outcome were carefully documented. RESULTS: A total of 50 patients aged 20-80 years, with a median age of 49 years, presented with features consistent with large bowel obstruction. Of these, 32 had simple sigmoid volvulus and were offered sigmoid colectomy and primary colorectal anastomosis, while 3 further patients with compound sigmoid volvulus had double resection with primary ileo-ileal and colorectal anastomosis. A patient with sigmoid volvulus had a Hartmann's procedure. Twelve patients had colon cancer, four had left hemicolectomy and primary colocolic anastomosis; three, sigmoid colectomy and primary colorectal anastomosis; three, low anterior resection and primary colorectal anastomosis; one decompressive colostomy and one, a right hemicolectomy and primary ileocolic anastomosis. The two patients with functional obstruction (Ogilvie syndrome) had tube caecostomy. All resections and primary anastomosis involving the right colon were preceded by antegrade on-table colonic lavage. One clinical anastomotic leak occurred in a low rectal anastomosis and minor wound infection in 10 patients. Operative mortality occurred in three patients with sigmoid volvulus. CONCLUSION: Adult large bowel obstruction is infrequent in our community and is caused commonly by sigmoid volvulus. Resection and primary anastomosis of the acute left-sided large bowel obstruction seems safe after antegrade on-table colonic lavage, provided bowel gangrene with peritonitis or any additional risk factor for anastomotic breakdown is not present.

Surveillance for African swine fever in Nigeria, 2006-2009.

African swine fever (ASF) has had significant economic and social impact in Nigeria since 1997. However, there has been no effective national response to bring it under control. In this report, we confirm that ASF is still prevalent and widespread in Nigeria. Results from both serosurveillance and virological analyses indicated that ASF is present in most of the agro-ecological zones of the country. Nine per cent (9%) of serum samples and 48% of tissue samples were positive for ASF virus antibody and genome, respectively. Areas with high pig-related activities (marketing, consumption and farming) have higher prevalences compared with areas with less pig activities. Farm-gate buyers, marketing systems and transport of untested pigs within the country assist with the circulation of the virus. Only by putting in place a comprehensive routine surveillance and testing system, reorganizing the market and transportation systems for pigs, implementing on-farm bio-security protocols and considering the option of compensation will it be possible to achieve a significant reduction in ASF prevalence in Nigeria.

Avian influenza A(H5N1) in humans: lessons from Egypt.

Highly pathogenic avian influenza A(H5N1) has ravaged the Egyptian poultry population. Ninety human cases, including 27 fatalities have been recorded by 30 December, 2009. However, epidemiological information on the infection in humans in Egypt is scarce. We analysed the first three years of highly pathogenic avian influenza A(H5N1) in Egypt between 20 March 2006 and 31 August 2009) and found that more cases occurred in females than males, especially in 2006 and 2007. Women in the age group 20-39 years had the greatest tendency to be infected. It took an average of one day and 18 hours to seek medical assistance in patients who recovered and of six days in fatal cases. Children sought treatment much earlier than adults. On average, a patient died 11 days after the onset of symptoms. Exposure to infected poultry remained the most important risk factor.

Effect of quinine administration on Purkinje cells in the cerebellar cortex of adult Wistar rats.

OBJECTIVE: The effect of quinine commonly used for the treatment of Chloroquine resistant malaria and cerebral malaria on the population and transverse diameters of Purkinje cells in the cerebellar cortex was investigated. METHODS: Twenty-seven adult male wistar rats weighing between 150 g and 190 g were separated into three groups, each containing nine rats. The rats in group I were injected intramuscularly with equivalent volume of physiological saline, while group II rats were injected intramuscularly with an initial 20 mg/kg body weight dose of quinine followed by a 10 mg/kg body weight dose given 8 hourly for 7 days. The group III rats received the same treatment as group II, but were subjected to a withdrawal period of one week. The cerebellum of each rat was removed and fixed in 10% formol saline for routine histological procedures. RESULTS: The Purkinje cell population reduced significantly (P < 0.05) from the mean value of 363 +/- 5.2 cells/mm2 in group I to a mean value of 239 +/- 9.5 cells/mm2 in group II and 220 +/- 6.6 cells/mm2 in group III rats. The transverse diameters of the Purkinje cells also reduced significantly (p < 0.05) from the mean value of 1.20 +/- 0.02 microm in the group I to a mean value of 1.09 +/- 0.1 microm in group II and 0.75 +/- 0.03 microm in group III. CONCLUSION: The observed decrease in population and diameters of Purkinje cells in the treatment groups may impair cerebellar functions since they are the principal neurons of the cerebellum.