CHALLENGES OF RENAL REPLACEMENT THERAPY IN NIGERIA: SOLUTIONS FROM MEDICAL STUDENTS' PERSPECTIVES.

Introduction: During our posting at the Renal Unit, Department of Medicine, University College Hospital, Ibadan, we observed numerous difficulties encountered by patients requiring renal replacement therapy and the family members/caregivers of these patients. These are broadly categorized into patents' related challenges, institutional inadequacies, infrastructural challenges, policy, and funding issues. Perspective: Patients' challenges are poor health-seeking habits culminating in late diagnosis in advanced uremic state and poor economic status resulting in catastrophic out-of-pocket spending. Institutional and infrastructural challenges include epileptic power supply in the dialysis unit, a lack of necessary materials needed for dialysis, among others. Policy issues included the absence of an organ donor system and regulations guiding them. More importantly, there is insufficient support from the government concerning patients with end-stage kidney disease. Conclusion: Tackling the management of end-stage kidney disease would require paying attention to and addressing these challenges.

RESPONSE TO THE COVID-19 OUTBREAK: LESSONS FROM A TERTIARY HEALTHCARE FACILITY IN SOUTHWEST NIGERIA.

Background: Mitigating the risk of nosocomial infection is one of the core functions of healthcare managers in hospital environments. This study aimed to describe the COVID-19 outbreak response in a tertiary healthcare facility in Nigeria. Methods: A qualitative cross-sectional study was conducted among representatives of Heads of Infection Control Committees and units, the Accident and Emergency unit, Family Medicine unit, and Private Suites on the COVID-19 outbreak response at the University College Hospital, Ibadan, Nigeria. Data were analyzed using Colaizzi's phenomenological method. Results: Overall, seven (six physicians and one nurse) HCWs were interviewed; six (71.4%) males and two (28.6%) females. The average age of the key informants was 45 ± 4.73 years. Four themes were identified. Theme one "Essentials of screening protocol and screening area" described the development of screening protocol, and dedication of a triage area. Theme two "Infection prevention and control within consultation premises" detailed adequate spacing; hand hygiene, use of personal protective equipment; environmental sanitation; and waste management. Theme three "Mounting up surveillance in the response activity" specified communication with the Disease Surveillance Unit; and surveillance activities. Theme four "Training and psychosocial support for staff " described staff training, and provision of psychosocial care to infected staff. Conclusion: The COVID-19 outbreak measures implemented by the management of the University College Hospital, Ibadan were aimed at ensuring that the hospital does not get overwhelmed by the surge in COVID-19 cases. In order to improve outbreak response in hospital settings, it is important to undertake training, modify hospital practices, and evaluate implemented measures.

Sceletium tortuosum: A review on its phytochemistry, pharmacokinetics, biological, pre-clinical and clinical activities.

ETHNOPHARMACOLOGICAL RELEVANCE: Sceletium tortuosum (L.) N.E.Br., the most sought after and widely researched species in the genus Sceletium is a succulent forb endemic to South Africa. Traditionally, this medicinal plant is mainly masticated or smoked and used for the relief of toothache, abdominal pain, as a mood-elevator, analgesic, hypnotic, anxiolytic, thirst and hunger suppressant, and for its intoxicating/euphoric effects. Sceletium tortuosum is currently of widespread scientific interest due to its clinical potential in treating anxiety and depression, relieving stress in healthy individuals, and enhancing cognitive functions. These pharmacological actions are attributed to its phytochemical constituents referred to as mesembrine-type alkaloids. AIM OF THE REVIEW: The aim of this review was to comprehensively summarize and critically evaluate recent research advances on the phytochemistry, pharmacokinetics, biological, pre-clinical and clinical activities of the medicinal plant S. tortuosum. Additionally, current ongoing research and future perspectives are also discussed. METHODS: All relevant scientific articles, books, MSc and Ph.D. dissertations on botany, behavioral pharmacology, traditional uses, and phytochemistry of S. tortuosum were retrieved from different databases (including Science Direct, PubMed, Google Scholar, Scopus and Web of Science). For pharmacokinetics and pharmacological effects of S. tortuosum, the focus fell on relevant publications published between 2009 and 2021. RESULTS: Twenty-five alkaloids belonging to four structural classes viz: mesembrine, Sceletium A4, joubertiamine, and tortuosamine, have been identified from S. tortuosum, of which the mesembrine class is predominant. The crude extracts and commercially available standardized extracts of S. tortuosum have displayed a wide spectrum of biological activities (e.g. antimalarial, anti-oxidant, neuromodulatory, immunomodulatory, anti-HIV, neuroprotection) in in vitro or in vivo studies. While the plant has been studied in clinical populations, this has only been in healthy subjects, so that further study in pathological states remains to be done. Nevertheless, the aforementioned studies have demonstrated that S. tortuosum has potential for enhancing cognitive function and managing anxiety and depression. CONCLUSION: As an important South African medicinal plant, S. tortuosum has garnered many research advances on its phytochemistry and biological activities over the last decade. These scientific studies have shown that S. tortuosum has various bioactivities. The findings have further established the link between the phytochemistry and pharmacological application, and support the traditional use of S. tortuosum in the indigenous medicine of South Africa.

Sceletium tortuosum: A review on its phytochemistry, pharmacokinetics, biological and clinical activities.

ETHNOPHARMACOLOGICAL RELEVANCE: Sceletium tortuosum (L.) N.E.Br, the most sought after and widely researched species in the genus Sceletium is a succulent forb endemic to South Africa. Traditionally, this medicinal plant is mainly masticated or smoked and used for the relief of toothache, abdominal pain, and as a mood-elevator, analgesic, hypnotic, anxiolytic, thirst and hunger suppressant, and for its intoxicating/euphoric effects. Sceletium tortuosum is currently of widespread scientific interest due to its clinical potential in treating anxiety and depression, relieving stress in healthy individuals, and enhancing cognitive functions. These pharmacological actions are attributed to its phytochemical constituents referred to as mesembrine-type alkaloids. AIM OF THE REVIEW: The aim of this review was to comprehensively summarize and critically evaluate recent research advances on the phytochemistry, pharmacokinetics, biological and clinical activities of the medicinal plant S. tortuosum. Additionally, current ongoing research and future perspectives are also discussed. METHODS: All relevant scientific articles, books, MSc and Ph.D. dissertations on botany, behavioral pharmacology, traditional uses, and phytochemistry of S. tortuosum were retrieved from different databases (including Science Direct, PubMed, Google Scholar, Scopus and Web of Science). For pharmacokinetics and pharmacological effects of S. tortuosum, the focus fell on relevant publications published between 2009 and 2021. RESULTS: Twenty-five alkaloids belonging to four structural classes viz: mesembrine, Sceletium A4, joubertiamine, and tortuosamine, have been identified from S. tortuosum, of which the mesembrine class is predominant. The crude extracts and commercially available standardized extracts of S. tortuosum have displayed a wide spectrum of biological activities (e.g. antimalarial, anti-oxidant, immunomodulatory, anti-HIV, neuroprotection, enhancement of cognitive function) in in vitro or in vivo studies. This plant has not yet been studied in a clinical population, but has potential for enhancing cognitive function, and managing anxiety and depression. CONCLUSION: As an important South African medicinal plant, S. tortuosum has garnered many research advances on its phytochemistry and biological activities over the last decade. These scientific studies have shown that S. tortuosum has various bioactivities. The findings have further established the link between the phytochemistry and pharmacological application, and support the traditional use of S. tortuosum in the indigenous medicine of South Africa.

Readiness for clinical practice amidst coronavirus among nursing students in southwest Nigeria.

BACKGROUND: COVID-19 is a public health problem that has claimed the lives of many men, women, and children globally, apart from its overwhelming economic impact. Nurses are inexorably faced with this situation as part of the frontline hospital workers, likewise student nurses on clinical practice while on training. OBJECTIVE: To assess readiness on resumption for clinical practice amidst coronavirus pandemic among Nursing students in South-West Nigeria. METHODS: This is a cross-sectional descriptive study that utilized a multistage sampling technique to select the respondents. Three-hundred respondents were recruited for the study. Data were analyzed using SPSS 22.0, descriptive statistics were presented in tables and charts while the hypotheses were tested with Chi-square at a significant level of p = 0.05. RESULTS: The findings revealed that the mean and standard deviation of the respondents was 22.16 ± 3.11 years; 61.7% were ready for clinical practice, 92(30.7%) were ready to nurse coronavirus patients. There is a significant difference between nursing institutions and readiness for clinical practice p = 0.000. There is no significant difference between years of clinical exposure and readiness for clinical practice p = 0.594. CONCLUSION: This study revealed that though the students had a high level of readiness, only few are ready to practice in coronavirus wards, this could pose a challenge to future nurses. It is important to build clinical competence and students' confidence to work in areas of infectious diseases like coronavirus.

Occurrence and probabilistic risk assessment of PAHs in water and sediment samples of the Diep River, South Africa.

This study investigated the levels of polycyclic aromatic hydrocarbons (PAHs) in water and sediment samples of the Diep River freshwater system of Western Cape Province, South Africa. A solid-phase extraction - gas chromatography - flame ionisation detection (SPE-GC-FID) method was utilised to simultaneously determine the 16 United States Environmental Protection Agency (US EPA) listed priority PAHs in water and sediment samples. The seasonal averages of individual PAH detected at the studied sites, ranged between not detected (Nd) and 72.38 ± 9.58 µg/L in water samples and between Nd and 16.65 ± 2.63 µg/g in the corresponding sediment samples. The levels of PAHs measured in water and sediment samples were subjected to probabilistic risk assessment to predict the possibility of regulatory values being exceeded. The average percentage exceedence of 63.26 was obtained for PAHs in water samples of the Diep River, while the corresponding average percentage exceedence obtained for sediment sample was 63.71. Sufficient exposure of humans and aquatic organisms to the exceedance levels obtained, would cause adverse health effect.

Preliminary Findings After Nonoperative Management of Traumatic Cervical Spinal Cord Injury on a Background of Degenerative Disc Disease: Providing Optimum Patient Care and Costs Saving in a Nigerian Setting.

OBJECTIVE: We assessed the hypothesis that nonoperative management would be a viable treatment option for patients with underlying degenerative disease who have traumatic cervical spinal cord injury (TCSI) without neurological deterioration and/or spinal instability during hospitalization. METHODS: Data were collected prospectively from 2011 to 2016. All the patients had been treated nonoperatively with hard cervical collar immobilization. The clinical parameters assessed included the Frankel grade at presentation and discharge, the occurrence of deep vein thrombosis, urinary tract infection, sphincter dysfunction, and pressure sores. The radiographic data collected included magnetic resonance imaging signal cord changes. P ≤ 0.05 represented a significant association between the Frankel grade at presentation and the outcome parameters. RESULTS: A total of 28 patients were included in the present study. Of the patients who had presented with Frankel grade B, 85.71% had improved to a higher grade, 90.91% of the patients with Frankel grade C had improved to a higher grade, and 14.29% of the patients with Frankel grade D had improved to Frankel grade E. All the patients had satisfactory spinal stability, as evidenced by dynamic radiographs, after treatment. CONCLUSION: The findings from the present study have shown that nonoperative management can result in improved neurological outcomes for patients with underlying degenerative disease who have experienced TCSI without evidence of neurological deterioration and spinal instability. The Frankel grade at presentation was significantly associated with outcome parameters such as the neurological outcome on discharge and the occurrence of urinary tract infection. The results from the present study could be helpful to neurological surgeons in rural and other low-resource settings because the cost savings realized by nonoperative treatment will not sacrifice the provision of adequate care to their patients.

Discordant rapid HIV tests: lessons from a low-resource community.

OBJECTIVES: HIV rapid antibody tests are widely used in Africa, but dual testing sometimes produces discordant results. It is not clear if discordant rapid HIV tests should always heighten suspicion by frontline health workers that early HIV infection is present. Some studies have reported that discordant rapid tests have value for identifying early HIV infection in high HIV prevalence populations. It is not known if rapid test performance influenced this conclusion, or if this observation will hold true for low HIV prevalence populations. We therefore explored the occurrence of discordant rapid HIV tests in a low-resource community. METHODS: A cross-sectional sample of HIV status-unaware adults with recent exposure to unsafe sex was assessed using a validated risk-based tool (University of North Carolina (UNC)-Malawi Risk Screening Score) for acute HIV infection. Participants received rapid testing with Determine™ HIV 1/2 and Uni-Gold™ HIV assays, plus plasma HIV-1 antigen testing with the COBAS® Ampliprep/COBAS® Taqman® HIV-1 assay, followed by western blot in those with detected HIV-1 antigen. RESULTS: Of 408 participants, 1.0% were confirmed to have established HIV infection. The discordance between rapid tests at initial screening was 2.45 and 2.94% when the two assays were used sequentially and simultaneously, respectively. Discordant rapid tests were strongly associated with risk scores > 2 [odds ratio (OR) 10.88; 95% confidence interval (CI) 2.35-50.43], and with detected HIV-1 RNA (OR 26.06; 95% CI 3.91-173.60). CONCLUSIONS: When the sample occurrence of discordance between the first and second tests is below 5%, discordant rapid tests in an adult with sexual risk behaviour should trigger strong suspicion of early HIV infection in low HIV prevalence populations.

A reduction in errors is associated with prospectively recording them.

OBJECT: Error recording and monitoring is an important component of error prevention and quality assurance in the health sector given the huge impact of medical errors on the well-being of patients and the financial loss incurred by health institutions. With this in mind, assessing the effect of reporting errors should be a cause worth pursuing. The object in this study was to examine the null hypothesis that recording and publishing errors do not affect error patterns in a clinical practice. METHODS: Intraoperative errors and their characteristics were prospectively recorded between May 2000 and May 2013 in the neurosurgical practice of the senior author (M.B.). The error pattern observed between May 2000 and August 2006, which has been previously described (Group A), was compared with the error pattern observed between September 2006 and May 2013 (Group B). RESULTS: A total of 1108 cases in Group A and 974 cases in Group B were surgically treated. A total of 2684 errors were recorded in Group A, while 1892 errors were recorded in Group B. The ratios of cranial to spinal procedures performed in Groups A and B were 3:1 and 10:1, respectively, while the ratios of general to local anesthesia in the two groups were 2:1 and 1.3:1, respectively (p < 0.0001 for both). There was a significantly decreased proportion of cases with error (87% to 83%, p < 0.006), mean errors per case (2.4 to 1.9, p < 0.0001), proportion of error-related complications (16.7% to 5.5%, p < 0.002), and clinical impacts of error (2.7% to 1.0%, p < 0.0001) in Group B compared with Group A. Errors in Group B tended to be more preventable than those in Group A (85.8% vs 78.5%, p < 0.0001). A significant reduction was also noticed with most types of error. A descending trend in the mean errors per case was demonstrated from the years 2001 to 2012; however, an increased severity of errors (22.6% to 29.5%, p < 0.0001) was recorded in Group B compared with Group A. CONCLUSIONS: Data in this study showed that the act of recording errors might alter behaviors, resulting in fewer errors.

A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats.

A mixture of 2% lignocaine (LIG) and 0.5% bupivacaine (BUP), at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP), was compared to LIG (4 mg/kg) and BUP (1 mg/kg) for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg) and ketamine hydrochloride (10 mg/kg). Onset and duration of analgesia, and time to walking were determined. Associated changes in heart rate (HR), respiratory frequency (fR) and rectal temperature (RT) were recorded. Onset of analgesia with epidurally administered LIG-BUP (4.5 +/- 0.7 min), LIG (3.9 +/- 1.0 min) and BUP (5.0 +/- 1.0 min) was similar. Duration of analgesia with LIG-BUP (49.4 +/- 4.5 min) was significantly (P<0.05) longer than with LIG (40.2 +/- 1.0 min) but shorter than with BUP (79.4 +/- 6.3 min). There were no significant differences in times to standing with LIG-BUP (26.3 +/- 6.4 min), LIG (20.4 +/- 4.7 min) and BUP (22.6 +/- 10.3 min). Minimal changes were observed in HR, fR and RT. In conclusion, duration of analgesia produced by LIG-BUP was shorter compared with BUP but longer compared with LIG. Neither LIG nor LIG-BUP has any advantage over epidural BUP in terms of onset of analgesia, time to standing and physiological responses. Therefore, lumbosacral epidural administration of BUP appears to be the best choice for a long surgical procedure lasting more than 1 hour when compared with either LIG or LIG-BUP.

Perceived family support and blood glucose control in type 2 diabetes

This study aimed to find out if levels of family support are correlated with blood glucose control among Nigerians with type 2 diabetes. One hundred and fifty (150) patients attending the diabetes clinic of the University College Hospital, Ibadan, were assessed for their perception of family support using a validated family support measure. Fasting plasma glucose was used as the index of glycaemic control, and 39% of subjects were rated as having 'strong' perceived family support, while 31% and 11% were rated wth 'weak' and 'no' perceived family support, respectively. Mean fasting plasma glucose was 7.0±2.5 mmol/L, with lower levels of blood glucose in those who perceived their family as supportive, compared with those who perceived their family as unsupportive. Positive family support was found to correlate positively with blood glucose control

Influence of dosage and chemical restraints on feline excretory urography.

Three series of trials involving 10 domestic short-haired cats were carried out to determine the influence of dosage of contrast media or type of chemical restraint on feline excretory urography. The 1st series (group A) involved 5 cats sedated with 2.0 mg/kg intramuscular (i.m) injection of 2% xylazine and receiving 800 mg/kg of 76 % meglumine diatrizoate (urografin). The 2nd series (group B) involved another 5 cats sedated with 2.0 mg/kg (i.m) injection of 2% xylazine and receiving 1200 mg/kg of 76% urografin. The 3rd series (group C) involved the repeat urography of the group B cats but sedated with 15 mg/kg (i.m) injection of 5% ketamine hydrochloride. Ventrodorsal radiographs were obtained immediately, 5, 15 and 40 minutes after the injection of 76% urografin. Scores were assigned to nephrographic opacification as described in the literature. The heart rates, respiratory rates and rectal temperatures of the cats were also determined before sedation, after sedation, immediately after the injection of 76% urografin and at 15-minute intervals over a period of 60 minutes. In this study, there were significant differences (P < 0.05) in the nephrographic opacification scores between the group A and group B cats at times 0 and 40 minutes post-administration of urografin. Group A cats had good initial nephrographic opacification which faded later while the nephrographic opacification of group B cats progressively increased. Similarly, nephrographic opacification was significantly (P < 0.05) higher in the xylazine-sedated cats (groups A and B) than the ketamine-sedated cats (group C). However, there were no significant differences (P > 0.05) in heart rates, respiratory rates and rectal temperatures between the 3 groups of cats. It was therefore concluded that increasing the dosage of urografin above 800 mg/kg in cats does not provide additional beneficial effects on the nephrograms produced. Xylazine sedation was observed to produce better nephrographic opacification, however, with delayed nephrographic fading compared to ketamine sedation.

Nigerian study offers insights on the successful introduction of Norplant.

PIP: The results of a recently completed study indicate that Nigerian women find Norplant to be an acceptable and effective method of contraception. In 1989, the Association for Voluntary Surgical Contraception (AVSC) initiated a 2-year study of Norplant use in Nigeria. Conducted in 5 hospitals, the study compared the characteristics of Norplant acceptors with those of women choosing other modern contraceptive methods (injectables, IUDs, or sterilization). 6994 women, 18% of whom chose Norplant, took part in the study. The study found that those women choosing Norplant tended to be young and have fewer children than the women who opted for sterilization. On average, Norplant users, were 30 years of age and had 4 living children. Most were married, lived in urban areas, and had either a primary or secondary level or education. 54% of Norplant users expressed a desire for more children in the future. The women reported choosing Norplant because of its efficacy, convenience of use, and long-term protection. Because of the thorough counseling on the possible side effects of Norplant (mainly menstrual irregularities), most women were able to cope well with them. After 6 months of use, more than 95% of Norplant users said that they would recommend the method to a friend. And at the conclusion of the 2-year study, only 12% of the women had discontinued the use. The reason most commonly cited for removal was menstrual problems, followed by the desire for another pregnancy. Soon, Nigeria is expected to grant Norplant formal approval. AVSC plans to work with the country's Ministry of Health in expanding the availability of the method.^ieng

Retrospective evaluation of xylazine/halothane anesthesia in 125 cattle.

A retrospective morbidity and mortality study was carried out on 125 case records of cattle involving xylazine/halothane anesthesia at the Ontario Veterinary College, Guelph between May 1979 and February 1983.One hundred and six animals were given xylazine intramuscularly with a mean dose of 0.22 mg/kg and the remaining 19 were given a mean dose of 0.17 mg/kg intravenously. When the animals became recumbent, they were intubated and connected to an anesthetic machine which delivered halothane in oxygen.Anesthetic complications were recorded for ten cattle (8%) in the series and were mainly associated with regurgitation of ruminal contents, with or without aspiration. Three animals died as a result of the anesthetic procedure and in three other instances there were complications which were potentially fatal. Two of the anesthetic deaths were directly attributable to faulty technique rather than a specific drug response.The use of xylazine/halothane was judged to be clinically satisfactory and did not produce an unacceptable complication rate, although it is evident there is a significant risk associated with general anesthesia in ruminants.