DEMOGRAPHICS OF COLLABORATORS INVESTIGATING THE NIGERIAN MEDICAL AND DENTAL INTERNS: A MEDICAL INTERNSHIP TRAINING IN NIGERIA (MINTING) STUDY COLLABORATION.

Introduction: The internship period is a peculiar time in a doctor's career, and some have described it as a "nuisance year" during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria. Methodology: A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study. Results: Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative. Conclusion: This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCN collaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force.

Effect of kolaviron, a biflavonoid complex from Garcinia kola seeds, on the antioxidant, hormonal and spermatogenic indices of diabetic male rats.

The antihyperglycaemic effect of kolaviron (KV), a biflavonoid from Garcinia kola has been established in previous studies. In this study, we investigated the effect of KV (200 mg kg(-1) ) on the antioxidant, hormonal and spermatogenic indices of alloxan-diabetic male rats, and metformin hydrochloride (MET) (30 mg kg(-1) ) served as standard drug. The results showed that KV and MET significantly (P < 0.05) decreased the fasting blood glucose of the diabetic rats. Also, untreated and MET-treated diabetic groups had significantly (P < 0.05) lower body-weight gain and relative weights of testes. In addition, epididymal sperm abnormalities were increased, whereas sperm count, motility, testicular protein and sialic acid were decreased in untreated diabetic group. Also, antioxidant parameters, reduced glutathione, catalase, superoxide dismutase, glutathione-S-transferase and glutathione peroxidase were significantly (P < 0.05) reduced in the testes with a concomitant increase in lipid peroxidation in untreated diabetic group. Furthermore, untreated diabetic group had significantly (P < 0.05) lower levels of testosterone, luteinising and follicle-stimulating hormones relative to controls. Treatment with KV restored the relative weights of testes, activities of antioxidant enzymes, sperm and hormonal indices of the diabetic animals. This study demonstrated the role of KV to promote fertility in diabetic male rats by enhancing the hormonal and antioxidant status of the rats.

Alcohol consumption and heart failure in hypertensives.

Sixty hypertensives (30 with and 30 without heart failure, matched for age and sex) were studied and their alcohol consumption and its possible role in heart failure were assessed. The majority in each group belonged to the low socioeconomic class. On presentation, the mean systolic blood pressures were 176.7 +/- 29.7 and 198.8 +/- 29.8 mmHg and diastolic blood pressures 118 +/- 15 and 118.5 +/- 13.6 mmHg, respectively. In those known to be hypertensive before presentation to our unit, hypertension was first detected 4.88 +/- 3.8 and 4.40 +/- 3.3 years earlier in the heart failure and non-heart failure groups, respectively. Drug compliance was similarly poor in the two groups. Of all 12 drinkers in heart failure, 75% drank heavily, while only 18.2% (two of 11) of the non-heart failure drinkers drank heavily. Nine (30%) and two (6.7%) of the heart failure and the non-heart failure groups, respectively, took > or = 80 g of alcohol daily for at least 3 years (P < 0.02). Significantly more of the heart failure group were thiamine deficient, although the deficiency could not be directly attributed to alcohol. The odds ratio for heavy and moderate alcohol consumption was 5.9 and 0.9, respectively. Thus it is suggested that heavy alcohol consumption appears to be a major contributory factor to heart failure in these patients.

A review of referred IUCD related problems in Lagos University Teaching Hospital.

A review of 168 patients referred with IUCD related problems was done. The two most common indications for referrals were difficulty at removal (73.8%) and missing/lost IUCD thread 23.8%. In 22.5% (9) of cases referred as missing/lost IUCD, the threads were visible on inspection of the cervix during speculum examination 21.4% (36) of the referred patients had routine removal by simple traction, while the retrieval hook was successfully used in 75% of the cases, only 3 patients (1.7%) required removal under general anaesthesia. A proper speculum examination combined with uterine sounding and the use of the retrieval hook at the peripheral centres will greatly reduce the need for referring IUCD related cases to a tertiary centre.

Pericardial effusion associated with minoxidil therapy: case reports.

Symptomatic pericardial effusion (PE) occurred in two of our patients with chronic renal failure (CRF) who had taken minoxidil for control of their hypertension. One of them died from the effects of cardiogenic shock due to cardiac tamponade. The 2 patients had taken minoxidil for over 3 months. Other patients who had CRF had not developed symptomatic PE while being treated with other anti-hypertensive agents. Our experience conforms with reports from elsewhere that minoxidil may cause PE. Therefore, patients with CRF who need minoxidil as an anti-hypertensive agent should be examined regularly for clinical evidence of PE.

Pericardial effusion associated with minoxidil therapy. [case reports]

Symptomatic pericardial effusion (PE) occured in two patients with chronic renal failure (CRF) who had taken minoxidal for control of their hypertension. One of them died from the effects of cardiogenic shock due to cardiac tamponade. This experience conforms with reports from elsewhere that minoxidil may cause PE. Therefore; patients with CRF who need minoxidil as an anti-hypertensive agent should be examined regularly for clinical evidence of PE

Erythrocyte membrane ouabain-sensitive Na+, K(+)-ATPase of hypertensive Nigerians.

An assessment of the ATPase functions of erythrocyte membrane of newly identified subjects having essential hypertension shows that Na+,K(+)-ATPase activity is higher in normal membranes than in membranes of individuals with essential hypertension. A study of the dependence of the enzyme on ATP in the presence of non-limiting concentrations of Na+ (120 mM) and Mg2+ (3 mM) shows that the pump in the membranes of hypertensive individuals, like that of normal humans, is easily saturable by ATP (greater than or equal to 2 microM). Analysis of the results of kinetic studies on the enzyme, in the presence of 5 mM K+, using the Hanes plot, reveals that, although the affinity (Km) of the pump for ATP is unaffected in essential hypertension, its maximum velocity (Vmax) is lower than in normal membranes. Even though the reason for a reduced sodium pump function in essential hypertension is not yet clear, it may not be unconnected with the presence of an endogenous inhibitor or with genetic or diet-induced membrane defects, as previously proposed by other workers in this area of research.

Inhibition of erythrocyte membrane Ca(2+)-pumping ATPase of hypertensive humans by nifedipine, a calcium entry blocker.

Nifedipine, a 1,4-dihydropyridine antihypertensive drug, inhibited the basal activity of erythrocyte Ca2+,Mg(2+)-ATPase of hypertensive individuals in a concentration-dependent manner. About 50% inhibition was obtained at nifedipine concentrations greater than or equal to 300 microM. The extent of inhibition of the ATPase action was increased in the presence of calmodulin. Maximal inhibition at 400 microM was 76%. Furthermore, the activity of the partially trypsinized enzyme was inhibited by about 50% by 300 microM nifedipine. Similar results were obtained with membranes from normotensive individuals. These findings suggest that nifedipine could prevent Ca(2+)-pumping by the erythrocyte Ca2+,Mg(2+)-ATPase.

Plasma levels of digitalis-like substance in Nigerians with essential hypertension.

A plasma Na+-K+ ATPase inhibitor, which is estimated by a technique in which it competes with ouabain for binding on red cells, was measured in three groups of individuals: (a) normotensive subjects without a family history of hypertension, (b) normotensive subjects with a family history of hypertension, (c) untreated essential hypertensive subjects. The mean value of the inhibitor in group (b) subjects was significantly higher than the mean value in group (a). The mean value in group (c) subjects was also significantly higher than in group (a) subjects. However, the means of the values in groups (b) and (c) were not significantly different. There was a significant positive correlation between the levels of the inhibitor and the urinary Na+ excretion in all subjects. However, there was no correlation between the inhibitor levels and mean arterial pressure. The relevance of these results to the pathophysiology of hypertension in the black African subject is discussed.

Mild hypertension in patients with suspected dilated cardiomyopathy: cause or consequence?

This study was undertaken to clarify the relationship between mild transient hypertension and dilated cardiomyopathy. Fifty-five patients were studied: group 1--controls (12 patients), group 2--hypertensives without clinical evidence of heart failure (14 patients), group 3--patients with hypertensive heart failure and diastolic blood pressure above 100 mmHg (10 patients), group 4--patients with possible dilated cardiomyopathy with mild hypertension, i.e. diastolic blood pressure of 90-100 mmHg (8 patients), group 5--patients with dilated cardiomyopathy and normal blood pressure (11 patients). The haemodynamic status and cardiac contractility indices were measured in each patient on admission, using M-mode echocardiography. Serum sodium and potassium as well as the urinary sodium, potassium and vanillyl mandelic acid excretions were also measured. The stroke volume, cardiac output and cardiac index fell with heart failure, but much more remarkably in group 4. The peripheral vascular resistance was higher in groups 2, 3 and 4 than in groups 1 and 5; so also were the aortic diameter, left posterior wall thickness and left ventricular mass. The plasma volume, aldosterone and cortisol levels were higher and the urinary sodium and potassium excretion lower in patients with heart failure (groups 3, 4 and 5). It is concluded that the raised blood pressure found in some patients suspected to have dilated cardiomyopathy is not due to the haemodynamic and biochemical changes that occur in heart failure. Such patients are 'chronic' hypertensives with hypertensive heart failure. Their presenting blood pressure is low because of their markedly reduced cardiac output.

Erythrocyte membrane Ca2+-pumping ATPase of hypertensive humans: reduced stimulation by calmodulin.

The Ca2+-pumping ATPase of erythrocyte plasma membranes of hypertensive humans (HTN) show, in the absence of calmodulin, a low Vmax comparable to that of the enzyme of the erythrocyte membranes of normotensive humans (NTN). Although the addition of calmodulin (1.5 micrograms per ml) increased the maximum activity of the calcium pump of membranes of HTN and NTN individuals by at least 2-fold and 4-fold, respectively, the activator protein partially purified from the erythrocytes of HTN individuals enhanced the activity of the enzyme in a fashion similar to that of the protein obtained from the haemolysate of NTN individuals. A determination of the dependence of the activity of the pump on concentration of ATP revealed that the Km (ATP) of the enzyme of membranes of HTN individuals is 52% higher than that of the enzyme of membranes of NTN individuals, while the Vmax (1.75 +/- 0.28 mumol ATP mg protein-1 h-1) of the pump is 46% lower in the membranes of HTN humans than that of the enzyme of membranes of normal individuals (3.25 +/- 0.42 mumol ATP mg protein-1 h-1). It seems likely from these results that elevated erythrocyte Ca2+ concentration associated with essential hypertension may be due to a defective interaction between the Ca2+-pumping ATPase and the calmodulin Ca2+ complex.