Paediatric Cardiac Anaesthesia at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria: The Hurdles, Struggles, and Successes.

BACKGROUND: Open-heart surgery started at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria, 5 years ago through partnership with foreign partners. This paper reviewed the difficulties facing the development of paediatric cardiac anaesthesia, the pattern, and the outcome of cases managed. METHODS: A review of the infrastructure, equipment, manpower and operational setup for open-heart surgery at OAUTHC was done. A retrospective study of all patients that were operated on from April 2016 to March 2021 was performed. Extracted data were analysed with Statistical Packages for the Social Scientists using descriptive statistics. RESULTS: A total of 102 patients had open-heart surgeries during the period under review by the various teams in a shared facility of the hospital's main theatre. Challenges with manpower, infrastructure, and supplies were major limitations to service delivery. Most of the patients (75.5%) were aged < 5 years. The commonest procedures performed were ventricular septal defect closure (31.4%), total correction of tetralogy of Fallot (26.5%), and atrial septal defect closure (9.8%). Fast-tracked anaesthesia was used always except where it was contraindicated. Most (76.7%) of the cases were extubated within 24 hours after surgery; the mean (SD) duration of ventilation in the ICU was 0.99 (1.2) days and the average length of ICU stay was 3 days. The overall mortality rate was 20.6%. CONCLUSION: Numerous challenges confront the provision of sustainable paediatric cardiac anaesthesia services in resource-constrained settings like ours. Much can be achieved with appropriate investment in material and manpower, and partnership with experienced teams.

CONTEXTE: La chirurgie à cœur ouvert a commencé au complexe hospitalier universitaire Obafemi Awolowo (OAUTHC) Ile-Ife, au Nigeria, il y a 5 ans grâce à un partenariat avec des partenaires étrangers. Cet article a passé en revue les difficultés rencontrées dans le développement de l'anesthésie cardiaque pédiatrique, le schéma et l'issue des cas pris en charge. MÉTHODES: Un examen de l'infrastructure, de l'équipement, de la main-d'œuvre et de la configuration opérationnelle pour la chirurgie à cœur ouvert à l'OAUTHC a été effectué. Une étude rétrospective de tous les patients opérés d'avril 2016 à mars 2021 a été réalisée. Les données extraites ont été analysées avec des progiciels statistiques pour les spécialistes des sciences sociales à l'aide de statistiques descriptives. RÉSULTATS: Au total, 102 patients ont été opérés à cœur ouvert au cours de la période étudiée par les différentes équipes dans une salle commune du bloc opératoire principal de l'hôpital. Les défis liés à la main-d'œuvre, à l'infrastructure et aux fournitures constituaient des obstacles majeurs à la prestation de services. La plupart des patients (75.5%) étaient âgés de < 5 ans. Les gestes les plus fréquemment pratiqués étaient la fermeture de la communication interventriculaire (31.4%), la correction totale de la tétralogie de Fallot (26.5 %) et la fermeture de la communication interauriculaire (9.8%). L'anesthésie accélérée a toujours été utilisée sauf en cas de contre-indication. La plupart (76.7%) des cas ont été extubés dans les 24 heures suivant la chirurgie ; la durée moyenne (ET) de la ventilation en USI était de 0.99 (1.2) jours et la durée moyenne de séjour en USI était de 3 jours. Le taux de mortalité global était de 20.6%. CONCLUSION: De nombreux défis font face à la prestation de services durables d'anesthésie cardiaque pédiatrique dans des contextes aux ressources limitées comme le nôtre. Beaucoup peut être réalisé avec un investissement approprié en matériel et en main-d'œuvre, et un partenariat avec des équipes expérimentées. MOTS-CLÉS: Pédiatrie, Anesthésie, Chirurgie Cardiaque, Nigéria, Pays en Développement.

Impact of post-tuberculosis lung disease on health-related quality of life in patients from two tertiary hospitals in Lagos, Nigeria.

BACKGROUND: Post-tuberculosis (TB) lung disease is a recognised cause of chronic respiratory disease, and its impact on health-related quality of life (HRQoL) has not been extensively described. OBJECTIVES: To describe the clinical profile, spirometry impairment and impact of post-TB lung disease on HRQoL among patients attending two tertiary hospitals in Lagos, Nigeria. METHODS: We conducted a cross-sectional study and obtained data through interviews, chart reviews and physical examination. We measured dyspnoea severity using the Medical Research Council (MRC) scale, HRQoL with the St George's respiratory questionnaire (SGRQ) and performed spirometry. Univariate regression was used to explore the associations between selected variables and HRQoL. RESULTS: A total of 59 participants were recruited and their median (interquartile range (IQR)) age was 45 (36 - 60) years. The most frequent symptom was cough (93.2%; n=55) and sputum production (91.5%; n=54). Less than two-thirds of the participants (62.4%; n=38) had received treatment for TB on more than one occasion, 50.8% (n=30) had moderate to very severe dyspnoea on the MRC scale and 88.7% (n=47/53) had abnormal spirometry with the mixed pattern predominating in 56.6% (n=30) of the participants. The mean (standard deviation (SD)) SGRQ component score for symptoms was 43.89 (18.66), followed by activity (42.50 (22.68)), impact (29.41 (17.82)) and total components (35.78 (17.25)). Dyspnoea, cough, sputum production and weight loss were associated with worsened HRQoL. CONCLUSION: Post-TB lung disease was characterised by a high symptom burden, severe spirometry impairment and poor HRQoL. There is a need for increased recognition and development of guidelines for diagnosis and treatment of post-TB lung disease and for further studies to explore preventive strategies.

Surgical Outcome of Treatment of Tracheobronchial Foreign Bodies in Children: A Retrospective Analysis.

BACKGROUND: Foreign body aspiration is an important cause of morbidity and potential mortality in children. The diagnosis of foreign body aspiration may be difficult in children as they are unable to give a history and the condition mimics a host of other childhood illnesses. In this study, we present our experience with foreign body aspiration in children. OBJECTIVES: To study the presentation of children with airway foreign bodies in our environment and discuss the outcomes of management. METHODS: This is a single centre retrospective study of all children who were confirmed to have tracheobronchial foreign body aspiration from January 2015 to December 2019. Biodata, clinical features, radiological features and outcome of management are presented in the article. Statistical analysis used: Measures of central tendency, dispersion and other relevant statistical analysis done with IBM SPSS® version 22. RESULTS: Twenty-one records were complete and analysed. The mean age was 5.95years with a M: F ratio of about 3:1. About 70% of the children presented more than 24 hours after the incident and the vast majority of aspirated objects were inorganic. About half of the children had received a prior wrong diagnosis. Majority of the foreign bodies were left sided (47.6%). Twenty of the 21 foreign bodies were successfully extracted. There were two mortalities recorded in this study. CONCLUSION: Foreign body aspiration is a life threatening condition. Physicians ought to consider this diagnosis in children presenting with unexplained acute respiratory symptoms.

CONTEXTE: L'aspiration de corps étranger est une cause importante de morbidité et de mortalité potentielle chez les enfants. Le diagnostic de l'aspiration de corps étranger peut être difficile chez les enfants car ils sont incapables de donner une histoire et la condition imite une foule d'autres maladies infantiles. Dans cette étude, nous présentons notre expérience avec l'aspiration de corps étrangers chez les enfants. OBJECTIFS: Étudier la présentation des enfants porteurs de corps étrangers des voies aériennes dans notre environnement et discuter des résultats de la prise en charge. MÉTHODES: Il s'agit d'une étude rétrospective monocentrique portant sur tous les enfants dont la ponction trachéobronchique de corps étrangers a été confirmée de janvier 2015 à décembre 2019. Les données biologiques, les caractéristiques cliniques, les caractéristiques radiologiques et les résultats de la prise en charge sont présentés dans l'article. ANALYSE STATISTIQUE UTILISÉE: mesures de tendance centrale, de dispersion et d'autres analyses statistiques pertinentes effectuées avec IBM SPSS® version 22. RÉSULTATS: Vingt et un dossiers ont été complets et analysés. L'âge moyen était de 5,95 ans avec un rapport M:F d'environ 3:1. Environ 70 % des enfants se sont présentés plus de 24 heures après l'incident et la grande majorité des objets aspirés étaient inorganiques. Environ la moitié des enfants avaient déjà reçu un mauvais diagnostic. La majorité des corps étrangers étaient du côté gauche (47,6%). Vingt des 21 corps étrangers ont été extraits avec succès. Deux décès ont été enregistrés dans cette étude. CONCLUSION: L'aspiration de corps étranger est une condition potentiellement mortelle. Les médecins devraient envisager ce diagnostic chez les enfants présentant des symptômes respiratoires aigus inexpliqués. MOTS-CLÉS: corps étranger, trachéobronchique, voie aérienne, aspiration, enfant, fluoroscopie.

Predictors of the usage of contraceptive implants among women of reproductive age in Ondo State, Southwest Nigeria.

BACKGROUND: A major characteristic of all developing countries is rapid population growth which is due to high fertility, birth rates and poor utilization of contraceptive methods. This study therefore assessed the predictors of contraceptive implants utilization among women of reproductive age in Ondo State, Nigeria. METHODS: A descriptive cross-sectional study design was used and a total of 230 women were selected by multi-stage sampling technique. Questionnaire administration was interviewer-based majority of the women could not read. Data analysis was conducted using SPSS version 23. Research questions and hypotheses were answered and tested with descriptive statistics (frequency, percentages), chi-square test of significance and binary logistic regression. Levels of significance was set at p ≤ 0.05. RESULTS: The prevalence of contraceptive utilization (any method) and contraceptive implant utilization were 92.2% and 31.1% respectively. Variables such as education (χ2 = 6.91, p = 0.03) and lack of counseling from providers (χ2 = 5.05, p = 0.03) were significantly associated with the utilization of contraceptive implant. These two variables were also the predictors of contraceptive implant utilization. Women with secondary and tertiary education have higher odds of utilizing contraceptive implants (OR = 1.21, 95% CI = 1.01-7.82, p = 0.04) and (OR = 2.53, 95% CI = 1.49-11.47, p = 0.03) compared to women who had primary or no education while those who claimed to be adequately counseled by providers are about two times more likely to use contraceptive implants (OR = 2.33, 95% CI = 1.08-5.51). CONCLUSION: This study showed the important role of education and health workers in providing information about contraceptive implants. Therefore, health workers' knowledge of family planning counseling and services should be constantly upgraded so as to improve their roles in educating, mobilizing, counseling the women regarding contraceptive implant insertion.

Aortic Valve Regurgitation following Transthoracic Open Surgical Ligation of Patent Ductus Arteriosus.

BACKGROUND: Transthoracic open surgical ligation (TTOSL) of patent ductus arteriosus (PDA) remains the most readily available and affordable treatment option in resource-poor countries such as Nigeria. OBJECTIVES: To determine the incidence and outcome of aortic valve regurgitation (AR) following TTOSL of PDA. METHODS: Retrospective audit of consecutive patients who underwent TTOSL of PDA over a 4½-year period (January 2015 to June 2019) at the OAUTHC, Ile-Ife, Nigeria. Hospital records including echocardiograms (pre-operative, immediate post-operative and follow-up performed a day after TTOSL, at 1, 3 and 12 months) were reviewed for presence and severity of AR. RESULTS: Twenty-six patients (11 males and 15 females) aged 3 months 24 years (Mean = 3.16 years) had TTOS PDA ligation. Only 3 (11.5%) patients had AR pre-operatively; 2 graded moderate AR and 1 graded mild. Twenty (76.9 %) patients had immediate post-operative AR; 4 (20.0%) of which were moderate and the others (80.0%) were mild. Eighteen (69.2%) patients still had AR post-operative day 1; 16 were mild and the rest 2 which were moderate were the same patients that had AR pre-operatively. At 3 months follow-up, 6 of 20 patients (30.0%) had AR; all were mild. Only 2 of 18 (11.1%) followed up for 12 months had AR. They both had had moderate AR pre-operatively which were now graded as mild. There was no mortality. CONCLUSION: Aortic regurgitation is common after TTOSL of PDA. However, in most instances, it is mild and transient.

Magainin-AM2 improves glucose homeostasis and beta cell function in high-fat fed mice.

BACKGROUND: Magainin-AM2, a previously described amphibian host-defense peptide, stimulates insulin- and glucagon-like peptide-1-release in vitro. This study investigated anti-diabetic effects of the peptide in mice with diet-induced obesity and glucose intolerance. METHODS: Male National Institute of Health Swiss mice were maintained on a high-fat diet for 12-weeks prior to the daily treatment with magainin-AM2. Various indices of glucose tolerance were monitored together with insulin secretory responsiveness of islets at conclusion of study. RESULTS: Following twice daily treatment with magainin-AM2 for 15 days, no significant difference in body weight and food intake was observed compared with saline-treated high fat control animals. However, non-fasting blood glucose was significantly (P<0.05) decreased while plasma insulin concentrations were significantly (P<0.05) increased. Oral and intraperitoneal glucose tolerance and insulin secretion following glucose administration via both routes were significantly (P<0.05) enhanced. The peptide significantly (P<0.001) improved insulin sensitivity as well as the beta cell responses of islets isolated from treated mice to a range of insulin secretagogues. Oxygen consumption, CO2production, respiratory exchange ratio and energy expenditure were not significantly altered by sub-chronic administration of magainin-AM2 but a significant (P<0.05) reduction in fat deposition was observed. CONCLUSION: These results indicate that magainin-AM2 improves glucose tolerance, insulin sensitivity and islet beta cells secretory responsiveness in mice with obesity-diabetes. GENERAL SIGNIFICANCE: The activity of magainin-AM2 suggests the possibility of exploiting this peptide for treatment of type 2 diabetes.

Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria.

BACKGROUND: There is evidence of an association between mediators of inflammation, particularly C-reactive protein (CRP), and outcome of acute ischaemic stroke. This provides a potential opportunity for interventions aimed at improving outcome. There is sparse data exploring the role of inflammatory markers such as CRP and stroke outcome in Africans. The study objective was to determine the association between admission serum CRP levels and short-term outcome in the Nigerian patient presenting with acute ischaemic stroke. MATERIALS AND METHODS: Consecutive patients hospitalized for first-ever acute ischaemic stroke at the Lagos University Teaching Hospital, Lagos, Nigeria, were prospectively enrolled between October 2007 and June 2008. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Serum CRP was determined on samples obtained within 7 days of stroke onset. All stroke patients were followed up till day 30 post-stroke. Outcome measures were 30 day Glasgow outcome scale score and functional impairment on the modified Rankin Scale (mRS). An age- and gender-matched healthy control group had serum CRP determined at inclusion. Elevated CRP was defined as any level above the cutoff (mean +2 x standard deviation of CRP level of controls). RESULTS: Eighty patients with acute ischaemic stroke (47 men and 33 women) and 40 controls (27 male and 13 female) (P = 0.47) were studied. Mean age in cases was 59.1 ± 15.0 years. Mean CRP was significantly higher in stroke cases than controls (17.7 ± 14.4 mg/L versus 1.1 ± 1.7 mg/L respectively) (P < 0.00001). The frequency of elevated CRP (>4.5 mg/L) was 76.3% in stroke (N = 61) and 5% (N = 2) in controls (P < 0.0001). The case fatality rate in stroke with elevated CRP (32.8%) was significantly higher than stroke with normal admission CRP (0%; P = 0.015). The association of higher admission CRP with fatality () was statistically significant (P < 0.0001). Amongst survivors, mean CRP levels were markedly higher in the patients with unfavorable motor outcome (moderate/severe disability; n = 22; 21.5 ± 11.1) compared to those with favorable outcome (mild disability; n = 38; 6.5 ± 6.2) (P < 0.00001). In multivariate regression analysis, only high NIHSS score (P = 0.004) and admission CRP (P = 0.008) were independently associated with case fatality. CONCLUSIONS: Elevated admission CRP and high NIHSS score are independent predictors of short-term case fatality and adverse functional outcome following acute ischaemic stroke in Nigerians.

Frog skin peptides (tigerinin-1R, magainin-AM1, -AM2, CPF-AM1, and PGla-AM1) stimulate secretion of glucagon-like peptide 1 (GLP-1) by GLUTag cells.

Skin secretions of several frog species contain host-defense peptides with multiple biological activities including in vitro and in vivo insulin-releasing actions. This study investigates the effects of tigerinin-1R from Hoplobatrachus rugulosus (Dicroglossidae) and magainin-AM1, magainin-AM2, caerulein precursor fragment (CPF-AM1) and peptide glycine leucine amide (PGLa-AM1) from Xenopus amieti (Pipidae) on GLP-1 secretion from GLUTag cells. Tigerinin-1R showed the highest potency producing a significant (P<0.05) increase in GLP-1 release at a concentration of 0.1nM for the cyclic peptide and 0.3nM for the reduced form. All peptides from X. amieti significantly (P<0.05) stimulated GLP-1 release at concentrations ⩾300nM with magainin-AM2 exhibiting the greatest potency (minimum concentration producing a significant stimulation=1nM). The maximum stimulatory response (3.2-fold of basal rate, P<0.001) was produced by CPF-AM1 at a concentration of 3µM. No peptide stimulated release of the cytosolic enzyme, lactate dehydrogenase from GLUTag cells at concentrations up to 3µM indicating that the integrity of the plasma membrane had been preserved. The data indicate that frog skin peptides, by stimulating GLP-1 release as well as direct effects on insulin secretion, show therapeutic potential as agents for the treatment of type 2 diabetes.

Regulation of GPCR-mediated smooth muscle contraction: implications for asthma and pulmonary hypertension.

Contractile G-protein-coupled receptors (GPCRs) have emerged as key regulators of smooth muscle contraction, both under healthy and diseased conditions. This brief review will discuss some key topics and novel insights regarding GPCR-mediated airway and vascular smooth muscle contraction as discussed at the 7th International Young Investigators' Symposium on Smooth Muscle (2011, Winnipeg, Manitoba, Canada) and will in particular focus on processes driving Ca(2+)-mobilization and -sensitization.

Protective effects of kolaviron and quercetin on cadmium-induced testicular damage and endocrine pathology in rats.

This study evaluated the effects of kolaviron, a biflavonoid from Garcinia kola seed, and quercetin on cadmium-induced reproductive toxicity in rats. Adult male rats were administered with either cadmium (15 mg kg(-1)) alone or in combination with kolaviron (200 mg kg(-1)) or quercetin (10 mg kg(-1)) daily for 5 days. Cadmium-treated rats showed (P < 0.05) decrease in the body weight gain, testis and epididymis weights. However, upon co-administration of kolaviron or quercetin, these changes were significantly reversed in cadmium-treated rats. Also, administration of kolaviron or quercetin significantly prevented cadmium-mediated decrease in sperm motility and epididymal sperm concentration and reversed the increased level of sperm abnormality to near control. In testes and sperm, cadmium treatment resulted in significant decrease in the activities of superoxide dismutase, catalase and glutathione peroxidase, whereas it increased glutathione S-transferase activity as well as hydrogen peroxide and malondialdehyde levels. While plasma levels of triiodothyronine and tetraiodothyronine remained unaffected, the levels of testosterone, luteinising hormone and follicle stimulating hormone were decreased in cadmium-treated rats. Cadmium treatment caused mild congestion of interstitial vessels and oedema in the testes. Taken together, kolaviron and quercetin inhibited the adverse effects of cadmium on the antioxidant enzymes, markers of oxidative stress, endocrine and testicular structure in rats.

Cardiovascular dysfunction in HIV-infected children in a sub-Saharan African country: comparative cross-sectional observational study.

OBJECTIVE: Cardiac dysfunction is rarely diagnosed in HIV-infected children in our setting and standard care does not include baseline and follow-up echocardiography. We aimed to determine the prevalence, pattern and predictors of HIV-related cardiac dysfunction. METHODS: Pre-diagnosed HIV-infected children aged 18 months to 12 years from a tertiary teaching hospital in Lagos, South-West Nigeria were enrolled in a comparative, observational cross-sectional study; matched with apparently healthy controls of the same age group, were recruited sequentially between May 2004 and 2007. Proportions of pre-defined cardiac abnormalities such as heart failure diagnosed by clinical examination and dilated cardiomyopathy and ventricular dysfunction by echocardiography were determined. RESULTS: Prevalence of cardiac abnormalities in HIV-infected children was 75.9%. Abnormalities included heart failure, dilated cardiomyopathy (33.7%), decreased LVSF of ≤ 25% in 33.7%, increased left ventricular mass (20.5%) and pericardial effusion (14.5%). CONCLUSION: Structural and functional abnormalities are prevalent in HIV-infected African children and therefore justify inclusion of routine echocardiography in their standard care.

Tigerinin-1R: a potent, non-toxic insulin-releasing peptide isolated from the skin of the Asian frog, Hoplobatrachus rugulosus.

AIM: Characterization of peptides in the skin of the Vietnamese common lowland frog Hoplobatrachus rugulosus with the ability to stimulate insulin release in vitro and improve glucose tolerance in vivo. METHODS: Peptides in an extract of skin were purified by reversed-phase HPLC, and their abilities to stimulate the release of insulin and the cytosolic enzyme lactate dehydrogenase were determined using BRIN-BD11 clonal ß cells. Insulin-releasing potencies of synthetic peptides and their effects on membrane potential and intracellular Ca²âº concentration were also measured using BRIN-BD11 cells. Effects on glucose tolerance and insulin release in vivo were determined in mice fed a high-fat diet to induce obesity and insulin resistance. RESULTS: A cyclic dodecapeptide (RVCSAIPLPICH.NH2), termed tigerinin-1R, was isolated from the skin extract that lacked short-term cytotoxic and haemolytic activity but significantly (p < 0.01) stimulated the rate of release of insulin from BRIN-BD11 cells at concentrations ≥ 0.1 nM. The maximum response was 405% of the basal rate at 5.6 mM ambient glucose concentration and 290% of basal rate at 16.7 mM glucose. C-terminal α-amidation was necessary for high potency and a possible mechanism of action of the peptide-involved membrane depolarization and an increase in intracellular Ca²âº concentration. Administration of tigerinin-1R (75 nmol/kg body weight) to high fat-fed mice significantly (p < 0.05) enhanced insulin release and improved glucose tolerance during the 60-min period following an intraperitoneal glucose load. CONCLUSION: Tigerinin-1R is a potent, non-toxic insulin-releasing peptide that shows potential for development into an agent for the treatment of type 2 diabetes.

Incorporating bioinformatics into biological science education in Nigeria: prospects and challenges.

The urgency to process and analyze the deluge of data created by proteomics and genomics studies worldwide has caused bioinformatics to gain prominence and importance. However, its multidisciplinary nature has created a unique demand for specialist trained in both biology and computing. Several countries, in response to this challenge, have developed a number of manpower training programmes. This review presents a description of the meaning, scope, history and development of bioinformatics with focus on prospects and challenges facing bioinformatics education worldwide. The paper also provides an overview of attempts at the introduction of bioinformatics in Nigeria; describes the existing bioinformatics scenario in Nigeria and suggests strategies for effective bioinformatics education in Nigeria.

The spectrum of malignant neoplasms in Ekiti State, south-west Nigeria.

BACKGROUND: Geographic pathology is an accepted basis for unravelling trends of disease patterns. Proper documentation at the initial stage assists in establishing a foundation data. The authors are not aware of a documented pattern of malignant neoplasm in Ekiti State. OBJECTIVE: The aim of this study is to update the available literature on malignant neoplasms and compare our findings with previous work done by other investigators. METHODS: The estimates are based on a systematic retrospective survey of cancer cases identified in the Pathology Laboratories of Federal Medical Centre, Ido-Ekiti and University Teaching Hospital, Ado-Ekiti for the period; January 2002 to December 2009. The data recorded on each case were: source of information (histology or cytology), name, age, and sex, date of diagnosis and site of tumour. Tumour site and histology were coded according to the International Classification of Diseases, ICD-10 for presentation in tabular form. RESULTS: A total of 498 cancers were recorded. There were 177 (35.5%) males with average age of 54.5 years and 321 (64.5%) females with average age of 48.6 years. The estimated Crude Incidence (CI) rates for all cancer sites are 14.7 for males and 27.4 for females, per 100,000 population. In males, the most frequent cancer is prostate cancer (37.9%) followed by cancer of the liver (10.7%) and NonHodgkin's Lymphoma, NHL (7.9%). In females, the most common cancer is that of the breast (49.3%) followed by the cervix (8.5%) and the ovary (5.32%). A total of 28 childhood cancers were registered (17 males, 11 females). The most frequent tumours were Burkitt's lymphoma (8 cases) and soft tissue sarcomas (3 cases). CONCLUSION: This study shows that malignant neoplasms are not uncommon in Ekiti State. There is underreporting of cases as the crude incidence rates are low. This study will serve as baseline to more population-based studies in future.

Plasma homocysteine level and its relationship to clinical profile in Parkinson's disease patients at the Lagos University Teaching Hospital.

BACKGROUND: Hyperhomocysteinaemia (HHcy) is as a long-term sequelum of levodopa therapy in Parkinson's disease (PD). Information on its frequency and effects in Africans with PD is sparse. OBJECTIVE: To determine the frequency of HHcy and its relationship to clinical features of PD in African patients. METHODS: Using a case-control design, 40 consecutively attending PD patients and 40 age- and gender-matched healthy volunteering controls were studied. Parkinson's disease cases were evaluated for disease and treatment characteristics, using the Unified Parkinson Disease Rating Scale (UPDRS) motor and activities of daily living scores and disease stage (Hoehn and Yahr scale). Fasting total plasma homocysteine (Hcy) was determined in all subjects. Hyperhomocysteinaemia was defined as a Hcy level above the 90th percentile for the controls. RESULTS: Mean Hcy was 13.8 ± 5.4mmol/L in PD and 12.4±3mmol/L in controls (P>0.05). Hyperhomocysteinaemia (Hcy > 16.26umol/L) occurred in nine (22.5%) PD patients (all on levodopa) and 6 (15%) controls (P>0.05). Mean duration of levodopa use was 92 ± 105.3 months in PD with HHcy compared to PD patients with normal Hcy 33.9 ± 33.2 (p < 0.05). Disease severity and disability were similar regardless of Hcy levels. None of current age, disease duration, Hoehn and Yahr stage, UPDRS scores, total levodopa dose and duration was independent predictor of homocysteine level. CONCLUSION: There is increased occurrence of hyper-homocysteinaemia in Nigerian subjects with Parkinson's disease, receiving Levodopa. This hyperhomocysteinaemia is more common with prolonged use but appears to have no relationship with disease severity or disability.

Determination of Antibodies to Hepatitis B Virus in Pregnant Women in Akure; Ondo State; Nigeria

The seroprevalence of hepatitis B virus (HBsAg) antibodies in pregnant women were determined using the rapid kit with double sandwich antibody procedure. Eight hundred and sixty pregnant women were recruited for this study. Out of this number forty (4.7) were positive while eight hundred and twenty (95.3) were negative; indicating an overall prevalence of 4.7. It therefore implies that the area under study showed low endemicity for the infection. It was also observed that health status of the women and their history of travels outside Akure; Ondo State was not associated with HBsAg seropositivity. The significance of these findings is discussed

Structural heart disease in children in Lagos: profile, problems and prospects.

OBJECTIVES: Structural heart disease (SHD) contributes significantly to the health burden of children in Nigeria, unfortunately comprehensive cardiovascular programme including definitive surgery is currently not available locally. This may have contributed to the paucity of research in paediatric cardiology. Available epidemiologic data are limited and mostly outdated. We studied the current distribution SHD in Lagos and compared findings with reports elsewhere. Problems and prospects associated with cardiovascular care at the study site were highlighted. MATERIALS AND METHODS: Children referred from public and private health facilities for cardiovascular evaluation including echocardiography between January 2004 and December 2005 were studied. PDA in premature babies, PFO and post surgical SHD were excluded. Proportions and relative frequencies of different heart lesions were calculated and analysed using appropriate statistics. RESULTS: Congenital heart disease (CHD) significantly outnumbered acquired heart disease (AHD) (p=0.0001) in these children aged 4 weeks to 15 years (mean age = 3.8 +/- 2.5 years); the relative frequencies were VSD (41.7%), VSD (41.7%), ASD (20.2%), TOF (11.8%), AVCD/ECD (7.0%), PDA (5.7%), PS (3.1%), single ventricle and TGA (2.2%) each. PS was dominant in males, while septation defects were dominant in females. Pericarditis with effusion (31%), RHD (28.6%), myocarditis (14.3%) and dilated cardiomyopathy (14.3%) were the commonest AHD. CONCLUSION: Contrary to previous hospital reports CHD rather than RHD and other AHD are dominant in some African settings like Lagos, and their relative frequencies are similar to reports elsewhere. The wide range of children with diverse native CHD is a reflection of non-availability of definitive surgical facilities locally. Regional and International collaboration could be mutually beneficial.

Studies of the antioxidative effects of green and black tea (Camellia sinensis) extracts in rats.

This paper reports a comparative study of the antioxidative effects of black and green tea extracts in sodium oxalate-challenged rats. A dose of 10 mg/kg of body weight of sodium oxalate was used to induce lipid peroxidation in vivo. Rats treated with sodium oxalate had 42.06 +/- 3.10 nM/hour, 45.39 +/- 9.75 mg/100 mL, 10.95 +/- 1.52%, 15.95 +/- 3.19 mg/dL, 112.25 +/- 5.15 mg/dL, 59.21 +/- 2.95 IU, 39.55 +/- 2.51 IU, and 150.62 +/- 9.62 KA/unit for serum levels of malondialdehyde, reduced ascorbic acid, catalase, cholesterol, phospholipid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP), respectively. These values are significantly (P < .05) different from values obtained from normal rats. Rats pretreated with 100 mg/kg of body weight of green tea had 27.59 +/- 3.56 nM/hour, 79.11 +/- 5.13 mg/100 mL, 4.23 +/- 0.36%, 50.09 +/- 5.24 mg/dL, 97.58 +/- 4.73 mg/dL, 23.10 +/- 1.59 IU, 31.14 +/- 1.26 IU, and 96.48 +/- 2.36 KA/unit for serum levels of malondialdehyde, reduced ascorbic acid, catalase, cholesterol, phospholipid, AST, ALT, and ALP, respectively, compared with 37.28 +/- 2.07 nM/hour, 72.62 +/- 2.10 mg/100 mL, 6.23 +/- 1.52%, 37.25 +/- 2.84 mg/dL, 78.05 +/- 2.36 mg/dL, 36.08 +/- 1.80 IU, 29.00 +/- 3.02 IU, and 109.23 +/- 6.32 KA/unit recorded for the same parameters in rats treated with black tea. The cholesterol to phospholipid ratio was increased from 0.14 +/- 0.04 in control rats to 0.47 +/- 0.02 and 0.51 +/- 0.01 by black and green tea extracts, respectively. These results suggest that tea extracts have antioxidant properties and that green tea extract is more potent.

Antibacterial potency of methanol extracts of lower plants.

Antibacterial potency of methanol extracts of three green lower plants, Pneumatopteris afra, Platycerium bifurcatum and Nephrolepsis bisserata was determined using agar dilution method on clinical strains of Escherichia coli, Staphylococcus aureus, Klebsiella spp. and Salmomelia typhi. Antibacterial activities were observed at concentrations of 12.5, 25.0, 50.0 and 100.0 microg/ml. Their minimum inhibitory concentrations ranged from 12.5approximately 100 microg/ml. Extracts of P. afra and P. bifurcatum were most active. Antibacterial activities observed with N. bisserata were less pronounced with no detectable activity at extract concentrations of 12.5 and 25.0 microg/ml. E. coli, together with S. aureus appeared to be the most susceptible of the test bacteria while Klebsiella spp. was least sensitive. The significance of our findings is discussed.

Knowledge and perception of stroke among at risk medical out-patients in a tertiary health institution in Nigeria.

BACKGROUND: Patients who recognize their increased risk of stroke are more likely to engage in stroke prevention practices than those who do not. METHOD: All patients attending medical out-patient clinic of the Federal Medical Center, Ido, Ekiti-State, Nigeria between January 2004-December 2004 were recruited into the screening process following their verbal consent. A set of questionnaire was administered to collect data. RESULTS: A total of 155 patients were studied having satisfied the inclusion criteria. The mean age of the patients was 58.4 +/- 18.7 years. Majority of the patients indicated paralysis of one side of the body as the most common symptom of stroke. Patients with higher education p = 0.002 and men p = 0.004 were more aware of their increased risk factor for stroke than those with low education and women. CONCLUSION: Perception about stroke among the at risk medical out patients as found out in this study indicates that more health education both at the community and the hospital is very vital to reducing the prevalence, recurrence, disability and mortality of stroke. Health providers are enjoined to communicate information about stroke risk to their patients.