Outpatient burden of adult respiratory diseases in University of Ilorin Teaching Hospital, Nigeria.

Background: Respiratory diseases constitute a significant cause of morbidity globally. There is limited information on the epidemiology of respiratory diseases in North Central Nigeria particularly with the changing trend in risk factors. Aim: This study aimed at evaluating the pattern and morbidity related to respiratory diseases among adult outpatients attending a chest clinic in a tertiary healthcare facility, especially with increasing environmental pollution and biomass exposure globally. Patients And Methods: This was a retrospective review of the case records of 338 newly referred patients seen in the chest clinic of the University of Ilorin Teaching Hospital (UITH) with respiratory illnesses over a 2-year period (January 2017-December 2018). Results: The mean age of the recruited patients was 47.6 ± 19.8 years with a male to female ratio of 1.1:1. Microbiologically confirmed tuberculosis (30.2%), chronic obstructive pulmonary disease (COPD) (24.3%), and bronchial asthma (17.8%) were the commonest conditions managed in the clinic. Overall, noncommunicable respiratory diseases (61.2%) constituted a larger proportion of cases when compared to infective respiratory conditions. Almost 90% of the patients were never smokers. Systemic hypertension (15.1%) and human immunodeficiency virus infection (3.6%) were the commonest comorbid illnesses. Conclusion: Although tuberculosis constituted the most observed single condition, noncommunicable respiratory diseases predominated cumulatively among the new cases seen in the chest clinic of UITH, Ilorin. This raises the need for significant attention in terms of prevention and management of noncommunicable respiratory diseases, which appear to be on the uprising.

Increased Risk of Migraine among Students with Asthma: Results of Headache and Asthma Study among University Students.

BACKGROUND: Several studies in developed countries have investigated the relationship between migraine and asthma. OBJECTIVE: To examine the relationship between asthma and migraine among university students in a low middle-income country. METHODS: We conducted a cross-sectional study across three universities in the middle belt region of Nigeria. A self-administered questionnaire developed from the International Classification of Headache Disorders was used to screen for migraine. The European Community Respiratory Health Survey (ECRHS) survey tool screened for asthma and its related conditions. Migraine was diagnosed in subjects with recurrent, moderate to severe unilateral throbbing headaches associated with nausea, vomiting, or visual disturbances. Asthma was defined as reporting a previous asthma attack or currently taking asthma medication within the preceding 12 months. RESULTS: The frequency of asthma was significantly higher among those with migraine than those without migraine (28.6% vs. 9.0%). Conversely, migraine was significantly prevalent in participants with asthma (7.1%vs. 1.9%). On multivariate analysis, there were significant associations between migraine and asthma [aOR = 2.56 (95% CI 1.15-5.77)]. Other factors associated with migraine were female gender [aOR = 2.22 (95% CI 1.06-4.65)] and family history of recurrent headache in firstdegree relatives [aOR = 4.03 (95% CI 1.15-5.77)]. CONCLUSION: Our study shows an increased frequency and risk of migraine in participants diagnosed with asthma and vice versa. These results support the bidirectional association between migraine and asthma. Physicians, therefore, should be aware of the possibility of migraine in patients with asthma who complain of headaches.

CONTEXTE: Plusieurs études menées dans des pays développésvont étudié la relation entre la migraine et l'asthme. OBJECTIF: Examiner la relation entre l'asthme et la migraine chez les étudiants universitaires d'un pays à faible revenu intermédiaire. MÉTHODES: Nous avons mené une étude transversale à travers trois universités dans la région de la ceinture centrale du Nigéria. Un questionnaire auto-administré élaboré à partir de la Classification internationale des troubles de la céphalée a été utilisé pour dépister la migraine. L'enquête de la Communauté européenne sur la santé respiratoire (ECRHS) outil d'enquête dépisté pour l'asthme et ses affections connexes. La migraine a été diagnostiquée chez des sujets présentant des maux de tête lancinants unilatéraux récurrents, modérés à sévères associés à des nausées, des vomissements ou des troubles visuels. L'asthme était défini comme la déclaration d'une crise d'asthme antérieure ou en cours de prise médicaments contre l'asthme au cours des 12 mois précédents. RÉSULTATS: La fréquence de l'asthme était significativement plus élevée chez les personnes souffrant de migraine que chez celles sans migraine (28,6% vs 9,0%). Inversement, la migraine était significativement répandue chez participants asthmatiques (7,1 % contre 1,9 %). Sur l'analyse multivariée, il y avait des associations significatives entre la migraine et l'asthme [aOR = 2,56 (IC à 95 % 1,15-5,77)]. Autres facteurs associés à la migraine étaient le sexe féminin [aOR = 2,22 (95 %IC 1,06­4,65)] et antécédents familiaux de maux de tête récurrents chez les parents de premier degré [RA = 4,03 (IC à 95 % 1,15-5,77)]. CONCLUSION: Notre étude montre une augmentation de la fréquence etrisque de migraine chez les participants ayant reçu un diagnostic d'asthme et de viceVersa. Ces résultats soutiennent l'association bidirectionnelle entre migraine et asthme. Les médecins devraient donc: être conscient de la possibilité de migraine chez les patients asthmatiques qui se plaignent de maux de tête. Mots-clés: Migraine, Maux de tête, Asthme, Allergie, Association, Relation.

Clinicopathological Pattern and Management of Primary Lung Cancer in Ilorin, Nigeria.

BACKGROUND: Lung cancer incidence and mortality rates have increased in some low and medium-resourced countries. OBJECTIVES: This study aimed to describe the clinicopathological pattern and management of lung cancer seen in our setting. METHODS: We reviewed cases of pulmonary neoplasm diagnosed and managed at the University of Ilorin teaching hospital over eight years. Cases with tissue diagnosis were enrolled in the study and relevant clinical data were collected from the medical record using a proforma. DESIGN: Hospital-based retrospective study. RESULTS: Out of the 71 cases of primary lung cancer reviewed, 44(62%) were males and the male to female ratio was 2:1. The mean age was 62±14 years and the occurrence was highest in aged 50-69 years. Thirty (42.3%) with histories of tobacco smoking were males. Adenocarcinoma accounted for 34(54.9%), 23(32.4%) were squamous cell carcinoma, 2(2.8%) were large cell carcinoma and 6(8.5%) were other histological variants. The majority (82.7%) presented at stage III-IV lung cancers, 56.3% had malignant pleural effusion and 74.6% received palliative care. Thirty-eight (53.3%) had chest tube drainage, 19(26.7%) underwent chemical pleurodesis and 22(31.0%) received Cisplatin-based systemic chemotherapy. One patient had curative surgery and none received radiotherapy. At 12 months, 4 (5.6%) were still alive, 14(19.7%) cases had medical records of their death and 53(74.7%) were lost to follow up. CONCLUSION: This study has highlighted the clinicopathological trend, high rate of mortality and late presentation of lung cancer in our setting. There is a need to increase the awareness of the warning signs and risk factors to ensure early detection and facilitate curative therapy.

CONTEXTE: L'incidence du cancer du poumon et les taux de mortalité ont augmenté dans certains pays à faibles et moyennes ressources. OBJECTIFS: Cette étude visait à décrire le modèle clinicopathologique et la prise en charge du cancer du poumon observé dans notre milieu. MÉTHODES: Nous avons passé en revue les cas de néoplasme pulmonaire diagnostiqués et pris en charge à l'hôpital universitaire de l'Université d'Ilorin pendant huit ans. Les cas avec diagnostic tissulaire ont été inclus dans l'étude et les données cliniques pertinentes ont été collectées à partir du dossier médical à l'aide d'un formulaire. CONCEPTION: étude rétrospective en milieu hospitalier. RÉSULTATS: Sur les 71 cas de cancer du poumon primitif examinés, 44 (62%) étaient des hommes et le ratio homme / femme était de 2:1. L'âge moyen était de 62 ± 14 ans et la fréquence était la plus élevée chez les 50 à 69 ans. Trente (42,3%) ayant des antécédents de tabagisme étaient des hommes. L'adénocarcinome représentait 34 (54,9%), 23 (32,4%) étaient des carcinomes épidermoïdes, 2 (2,8%) étaient des carcinomes à grandes cellules et 6 (8,5%) étaient d'autres variantes histologiques. La majorité (82,7%) des cancers du poumon de stade III-IV, 56,3% ont eu un épanchement pleural malin et 74,6% ont reçu des soins palliatifs. Trente-huit (53,3%) ont eu un drainage par sonde thoracique, 19 (26,7%) ont subi une pleurodèse chimique et 22 (31,0%) ont reçu une chimiothérapie systémique à base de cisplatine. Un patient a subi une chirurgie curative et aucun n'a reçu de radiothérapie. À 12 mois, 4 (5,6%) étaient encore en vie, 14 (19,7%) cas avaient un médical de leur décès et 53 (74,7%) étaient perdus de vue. CONCLUSION: Cette étude a mis en évidence la tendance clinicopathologique, le taux élevé de mortalité, et la présentation tardive du cancer du poumon dans notre milieu. Il est nécessaire d'accroître la sensibilisation aux signes avant-coureurs et aux facteurs de risque pour assurer une détection précoce et faciliter la thérapie curative. MOTS CLÉS: Clinico-pathologique, modèle, prise en charge, cancer du poumon, néoplasme, Nigéria.

Assessment of Post-Treatment Health-Related Quality of Life among Patients with Pulmonary Tuberculosis in Ilorin, Nigeria.

BACKGROUND: A lot of attention has generally been given to the microbiology and treatment of pulmonary tuberculosis with relatively limited consideration on its impact on the physical, psychological and social domains of the individual especially after successful drug treatment. AIM AND OBJECTIVES: This study aimed at assessing the health-related quality of life (HRQoL) and related factors among individuals who had successfully completed treatment for pulmonary tuberculosis (PTB) in Ilorin. METHODS: This was a hospital based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. HRQoL assessment was conducted in 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding three years using the validated St. George's Respiratory Questionnaire (SGRQ). All subjects also had plain chest radiograph done for assessment of the presence and extent of lung parenchymal damage. RESULTS: The overall total median percentage HRQoL score was 18.5 (7.9-28.2) with the highest score in the activity component [33.7 (18.3-41.8)] and least scores in the impact component [10.0 (0.0-21.9)]. The independent predictors of impaired HRQoL were age > 40 years (p= 0.007), absence of formal education (p=0.004), mMRC score >1 (p= 0.002), PTB retreatment (p=<0.001) and radiographic scores >3 (p= <0.001). CONCLUSION: There is impaired HRQoL following treatment for PTB in Ilorin. Hence, there is a need to incorporate HRQOL assessment as an adjunct outcome measure after PTB treatment especially in those with the above identified risk factors.

Air Quality Index and Respiratory Symptoms among Garri Processing Workers in Ogbomoso, Nigeria.

BACKGROUND: Epidemiological studies have linked morbidity and mortality of individuals to exposure to atmospheric gaseous and particulate matter especially fine particles (PM2.5) and coarse particles (PM10).The process of garri (cassava crisps) production (frying with firewood) is associated with production of gaseous and particulate matter which contribute to ambient particulate matter air pollution. The objective of this study was to determine the impact of air quality indices on the prevalence of respiratory symptoms among the garri processing workers in Ogbomoso. METHODOLOGY: A comparative cross-sectional study was carried out among 351 garri processing workers in Ogbomoso as subjects and 351 residents of Ogbomoso metropolis as controls that were age, sex and height-matched. A semi-structured questionnaire was used to obtain sociodemographic profiles and respiratory symptoms of participants and document physical examination findings. Particulate matter counter was used for air quality sampling. RESULTS: The mean age of subjects was 41.7 ± 14.9 years and that of controls was 41.6 ± 14.7 years (p =0.960). The two groups were also matched for socioeconomic status, sex and height. Prevalence of respiratory symptoms was higher at 48.4% among the garri workers than the control group which was 29.1% (p<0.001). Cough was the predominant symptom with a prevalence of 29.3% and 10.5% among the subjects and controls respectively. The mean count of PM1.0 in garri processing locations was significantly higher than that recorded in Ogbomoso metropolis; 73.77±42.08 vs 15.04±6.66mg/m3 (p<0.0001). CONCLUSION: Garri processing work is associated with significant increase in ambient air pollution and increased prevalence of respiratory symptoms among the workforce compared to the control population. Effective preventive strategies including education and provision of safety masks may reduce the occupational hazards associated with garri processing factory workers in Nigeria.

Acute Oxygen Therapy on Hospital Wards in Low Middle-Income Country: Experience from a Referral Centre in Ilorin, Nigeria.

BACKGROUND: Oxygen is like any other medication that can cause severe consequences if administered inappropriately. OBJECTIVE: To audit the pattern of acute oxygen therapy on regular hospital wards of a referral centre in Ilorin, Nigeria. METHODS: We reviewed 150 patients that received or had a prescription for acute oxygen therapy in three months and extracted relevant information using a proforma. RESULTS: About one-third of the patients (30%) were >65 years of age and the male to female ratio was 1:1. The commonest indication and medical condition for acute oxygen administration were hypoxemia (70.7%) and pneumonia (26.0%), respectively. Pneumonia accounted for most (41.2 %) of the oxygen therapy in childhood. The majority of patients (88.0%) had written order for oxygen prescription, 40.7% had a prescription to target oxygen saturation and only 31.3% achieved their target saturation. Oxygen prescription was adequate (documentation of delivery device, flow rate of oxygen, and target oxygen saturations) in 40.7% of patients. The assessment, monitoring and titration of oxygen therapy were adequate in 92.7%, 65.3% and 28 % of patients respectively. Overall mortality was 27.3% in patients receiving acute oxygen supplementation. Eleven patients had unstable COPD, and 63.6 %, 54.5 % and 45.6 % of them had adequate oxygen prescription, monitoring and titration respectively. The challenges to oxygen use were faulty delivery devices, emptied oxygen cylinders, inability to routinely do arterial blood gas analysis and lack of hospital oxygen protocol. CONCLUSION: The current practice of acute oxygen therapy is not satisfactory and interventions are advocated to improve the healthcare providers' administration of oxygen.

Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals.

BACKGROUND: Understanding the impact of asthma is the key to optimal care. OBJECTIVE: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. METHODS: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). RESULTS: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. CONCLUSION: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.

Knowledge and practice assessment, and self reported barriers to guideline based asthma management among doctors in Nigeria.

BACKGROUND AND OBJECTIVE: Doctors' knowledge contributes to practice and quality of care rendered to patients. To assess the knowledge and practice assessment and self reported barriers to guideline-based management among doctors. SUBJECTS AND METHODS: This was a cross-sectional study among doctors from various part of the country attending a continuing medical education (CME) program in Lagos, Nigeria. We used a self-administered, pretested, semistructured, validated questionnaire based on the Global Initiative for Asthma (GINA) guideline. RESULTS: Of the 98 participants, 41 (42%) and 18 (18.4%) had good level of asthma knowledge and practice, respectively. There was no relationship between level of knowledge and practice and the level of knowledge was not associated with the practice (X2 = 6.56, P = 0.16). The most reported barriers to good guideline-based practice were the unavailability of diagnostic and treatment facilities (44.3%), poor medication adherence (25.7%), and high cost of asthma medications (18.6%). CONCLUSION: The level of asthma knowledge and practice, respectively, among doctors in Nigeria is low and there is no relationship between level of knowledge and practice. Unavailability of diagnostic and treatment facilities, poor medication adherence, and high cost of medications are important barriers to good practice. There is a need to improve asthma education among doctors in Nigeria. Addressing barriers to good practice is essential for the translation of knowledge into practice.

Profile of patients with chronic obstructive pulmonary disease in Ilorin who were never-smokers.

BACKGROUND: The most recognized risk factor for chronic obstructive pulmonary disease (COPD) worldwide is cigarette smoking. However, recent surveys have revealed an increasing trend from nonsmoking causes especially from biomass exposure. This study, therefore, aimed to determine the proportion of patients and the clinical pattern of COPD among never-smokers in Ilorin. SUBJECTS AND METHODS: This is a retrospective study in which case records of patients with clinical diagnosis of COPD from January 2013 to December 2017 were reviewed. Data were collected with respect to their sociodemographic characteristics, clinical details, comorbid illnesses, and severity of the disease. RESULTS: A total of 135 case records of patients with COPD were reviewed, of which 66 had spirometric confirmation of the disease. In all, 38 (57.6%) of them were never-smokers with a male-to-female ratio of 1:1.1. The mean age of the subjects was 64.5 ± 11.7 years. Cough and exertional dyspnea were the most common symptoms (89.5% each), and systemic hypertension was the most common comorbid illness. Firewood exposure constituted the most common nonsmoking risk factor (47.4%), and the majority of the patients had mild COPD. When compared with ever-smokers, the mean post bronchodilator lung function parameters were found to be significantly better in never-smokers. CONCLUSION: Over half of COPD cases in Ilorin were never-smokers with firewood exposure as the main risk factor. This study has further highlighted the need for increased awareness of the hazards of biomass fuel exposure in our setting.

Antiseizure Effects of Ketogenic Diet on Seizures Induced with Pentylenetetrazole, 4-Aminopyridine and Strychnine in Wistar Rats.

The ketogenic diet (KD) is a cheap and effective alternative therapy for most epilepsy. There are paucity of experimental data in Nigeria on the usefulness of KD in epilepsy models. This is likely to be responsible for the poor clinical acceptability of the diet in the country. This study therefore aimed at providing experimental data on usefulness of KD on seizure models.  The study used 64 Wistar rats that were divided into two dietary groups [normal diet (ND) and ketogenic diet (KD)]. Animal in each group were fed for 35days. Medium chain triglyceride ketogenic diet (MCT-KD) was used and it consisted of 15% carbohydrate in normal rat chow long with 5ml sunflower oil (25% (v/w). The normal diet was the usual rat chow. Seizures were induced with one of Pentelyntetrazole (PTZ), 4-Aminopyridine (AP) and Strychnine (STR). Fasting glucose, ketosis level and serum chemistry were determined and seizure parameters recorded. Serum ketosis was significantly higher in MCT-KD-fed rats (12.7 ±2.6) than ND-fed (5.17±0.86) rats. Fasting blood glucose was higher in ND-fed rats (5.3±0.9mMol/l) than in MCT-KD fed rats (5.1±0.5mMol/l) with p=0.9. Seizure latency was significantly prolonged in ND-fed compared with MCT-KD fed rats after PTZ-induced seizures (61±9sec vs 570±34sec) and AP-induced seizures (49±11sec vs 483±41sec). The difference after Str-induced seizure (51±7 vs 62±8 sec) was not significan. The differences in seizure duration between ND-fed and MCT-KD fed rats with PTZ (4296±77sec vs 366±46sec) and with AP (5238±102sec vs 480±67sec) were significant (p<0.05), but not with STR (3841±94sec vs 3510±89sec) respectively. The mean serum Na+ was significantly higher in MCT-KD fed (141.7±2.1mMol/l) than ND-fed rats (137±2.3mMol/l). There was no significant difference in mean values of other serum electrolytes between the MCT-KD fed and ND-fed animals. MCT-KD caused increase resistance to PTZ-and AP-induced seizures, but has no effect on STR-induced seizures. This antiseizure property is probably mediated through GABAergic receptors (PTZ effect) and blockade of membrane bound KATP channels (AP effect) with some enhancement by serum ketosis.

Prevalence and clinical characteristics of headaches among undergraduate students in three tertiary institutions in Ilorin, Nigeria.

OBJECTIVE: Headache is a common chronic neurologic disorder with huge economic and psychosocial impact. In comparison with other neurological disorders, there is limited data on primary headache, especially from sub-Saharan Africa. This study was done to fill in the gap and provide recent information on headache among Nigerian undergraduate students. METHODOLOGY: Quota sampling was used to select students from three tertiary educational institutions within Ilorin, the capital of Kwara state. Two-stage self-administered questionnaires developed from the guideline of the International Society of Headache were used to harvest information. RESULTS: A total of 1500 students participated in the study. The mean age of the students was 20.9 ± 3.1 years, with male:female ratio of 1.6:1. A total of 356 students have frequent headache within previous 1 year, given the headache frequency of 23.7%. Fifty-three students (3.5%) had headaches on almost daily basis, 84 (5.6%) had ≥4 attacks/week, 145 (9.7%) had ≤2-3 attacks/month, and 123 (8.2%) had 1-3 attacks every 3 months. Close to 75% indicated that it limits their daily activity frequently. One hundred and eighty-seven (12.5%) students fulfilled the criteria for tension-type headache, 36 (2.4%) for migraine headache, and 133 (8.9%) had nonclassified headaches. The most frequent headache-associated symptoms are photophia - 100 students (6.7%), phonophobia - 159 students (10.6%), while 62 students (4.1%) had nausea and vomiting. None of the students had seen a physician for proper headache diagnosis. Majority (90.2%) used none prescription over-the-counter analgesia (acetaminophen) for symptomatic treatment of their aches. CONCLUSION: Headache is a common complaint among Nigerian undergraduate students and it limits the daily activity of majority of the sufferers. Students need proper education regarding treatment to alleviate their suffering and forestall complication, especially those associated with analgesic overuse.

Normal CD4 Count Range among Healthy Nigerian Population in Ilorin.

BACKGROUND: For the establishment and monitoring of the immune status, CD4 count is critical. OBJECTIVES: To determine the CD4 count range of apparently healthy Nigerians resident in Ilorin and compare with the national value. METHODS: An automated blood analyzer was used to determine the full blood count and CD4 count. The percentage of CD4 count was derived by using other variables. RESULTS: Of the 1205 participants, the reference CD4 count (percentage of CD4) range for adult was 400 to 1288 cells/mm3 (19%-48%) and for children was 582 to 3652 cells/mm3 (17%-50%). CD4 count and percentage of CD4 were significantly ( P = .001) higher in females than in males, and the CD4 count declined significantly with increasing age ( r = -.174, P ≤ .0001). The percentage of CD4 count shows less variation with age ( r = -.051, P = .076). Adult residents of Ilorin had significantly lower absolute mean CD4 count (808 ± 260) than that of the national reference values of 847.0 ± 307.0 cells/mm3 ( P = .001). CONCLUSION: We therefore advocate the use of CD4 count range derived in this study is lower than that of the national reference values.

Lung cancer awareness and anticipated delay before seeking medical help in the middle-belt population of Nigeria.

SETTING: Ilorin metropolis in the middle-belt region of Nigeria. OBJECTIVES: To determine the awareness about warning signs and risk factors for lung cancer and the anticipated delay before seeking medical care in the middle-belt population of Nigeria. DESIGN: This was a cross-sectional study performed among 1125 adults. Lung cancer awareness measure (Lung CAM) was administered face to face by trained interviewers. RESULTS: The respondents' Lung CAM score was low for warning signs and risk factors for lung cancer. Apart from tobacco smoking (69.9%) and air pollution (56.4%), other risk factors were poorly recognised by respondents. Higher education and income and having a relative or friends who had previously had lung cancer were significantly associated with awareness about warning signs and risk factors. The majority (66.8%) would seek help before 2 weeks if they noticed a warning sign. Anticipated delay was associated with non-recognition of any warning sign (OR 3.09, 95%CI 2.26-4.22), lower education (OR 1.90, 95%CI 1.40-2.57), lower income (OR 1.86, 95%CI 1.26-2.75) and males (OR 1.50, 95%CI 1.15-1.97). CONCLUSION: The awareness of lung cancer warning signs and risk factors are not satisfactory in Nigeria. There is a need to increase awareness about the condition to prevent delays in seeking medical help.

Prevalence and antibiotic susceptibility pattern of esbl producing klebsiellae isolated from clinical specimens in a nigerian tertiary hospital

Background: Infection by Extended Spectrum Beta Lactamases (ESBLs) producing bacteria is a threat to man as a consequence of treatment challenges. This study evaluated the prevalence and antimicrobial susceptibility pattern of ESBL producing Klebsiellae (EPK) in clinical specimens at the University of Ilorin Teaching hospital, Ilorin (UITH), Nigeria. Methods: ESBL production was assayed using Double Discs Synergy Test (DDST). Antimicrobial susceptibility was performed by Modified Kirby-Baeur method with the organism tested against ceftazidime (30µg), cefotaxime (30µg), amoxicillin clavulinic acid (20/10µg), cefepime (30µg), ciprofloxacin (5µg), gentamicin (10µg), trimethoprim-sulphamethoxazole (23.75/1.25µg), imipenem (10µg) and doripenem (10µg) (Oxoid, UK). Results: Fifty (26.7%) of the 187 Klebsiellae studied were EPK comprising of 37(26.8%) Klebsiella pneumoniae and 13(26.5%) Klebsiella oxytoca. EPK were mostly from wound specimens (24.0%) although Klebsiellae were mostly occurring in sputum (26.2%). The EPK were resistant to ceftazidime (100%), cefotaxime (94.0%), trimethoprim-sulphamethoxazole (92.0%), gentamicin (70.0%) and ciprofloxacin (70.0%) but 100% susceptible to both doripenem and imipenem. Conclusion: The prevalence of EPK in this study is high and they are multi-drug resistant. Carbapenems are the best antibiotic treatment option for infections arising from these organisms although a coordinated rational usage is desired along with functional antibiotic prescription policy to avoid treatment failures. Continuous surveillance for ESBL producing Klebsiellae and resistance monitoring are necessary routine to strengthen infection control policies

Self-reported sleep parameters among secondary school teenagers in middle-belt Nigeria.

BACKGROUND: Available evidences seem to suggest increasing trend in sleep deficit among teenagers worldwide, and there is limited information on this among Nigerian teenagers. This study was carried out to determine the basic sleep schedule and sleep duration among schooling teenagers in Ilorin, Nigeria. METHODS: This is a descriptive cross-sectional study conducted among 20 selected public secondary schools in Ilorin, Nigeria. A multistage sampling technique was used to randomly select participating schools. RESULT: A total of 1033 students participated in the study; of these 47.3% were males and 51.7% females. Students mean age (standard deviation) was 15.3 ± 1.6 years with a range of 12-19 years. Majority (76.2%) of participants co-share bed with at least one person and some (23.8%) slept alone in bed. The three leading reasons given for going to bed were: Tiredness - 31.1%, completion of house assignment - 20.5%, and parental directive - 12.4%. 10% of teenagers do make regular phone calls at night and 5.5% surf internet and use computers at night. Regular habits of daytime sleepiness were reported by 8.2% of study participants. Students' mean sleep duration during school days was 9.33 ± 2.29 h compared to 10.09 ± 1.32 h at weekend (P < 0.05). The duration of night time sleep was adequate (>9 h) in 41% of students; borderline (8-9 h) in 44.3% while 13.3% of the students had insufficient nighttime sleep duration (<8 h) P < 0.05. CONCLUSION: A substantial number of students had borderline nighttime sleep duration and so had potentials to transit into the problematic insufficient range. To prevent this, there is a need to educate schooling teenagers on the dangers associated with prolonged sleep insufficiency.

Evaluation of Inhaler Techniques among Asthma Patients Seen in Nigeria: An Observational Cross Sectional Study

Background: An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler-specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans. Aims: This observational study was to assess the inhaler techniques among asthma patients in Nigeria and also to identify the factors related to an inaccurate or poor inhaler use. Subjects and Methods: Consenting asthma patients on inhalers; who attended medical out-patients clinic; of two university hospitals in Nigeria were asked to use their inhalers while an inhaler-administration checklist was used to assess each patients inhaler technique. Information on demographics; asthma symptoms history and history of technique education were obtained. Data was analyzed using standard statistical methods. Results: A total of 140 asthma patients participated out of which 75 were females. All the patients used pressurized metered dose inhalers (pMDI) type; 51 of them used dry powder inhalers (DPI) in addition. For pMDI; 22.1 (31/140) completed all required steps while 37.3 (19/51) did so for DPI (P = 0.04). Patients with higher educational qualification (P 0.01) and those with less frequent asthma symptoms (P 0.01) are more likely to use the pMDI inhalers more accurately while patients who have been taught previously by a Doctor were more likely to use the DPI better. Conclusion: Majority of asthma patients use their inhalers inaccurately. Patient-dependent factors were identified as the cause of incorrect technique of inhaler use. Asthma patients on inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor

Respiratory symptoms and lung function patterns in workers exposed to wood smoke and cooking oil fumes (mai suya) in Nigeria.

BACKGROUND: 'Mai suya' is a common job in the most northern Nigeria in which there is significant exposures to wood smoke and oil fumes. The respiratory impact of these dual exposures on workers engaged in this work has not been previously documented, hence this study was carried out. AIM: The aim is to study the prevalence, patterns and respiratory function assessment among this group. SUBJECT AND METHODS: This is a case controlled study involving mai suya and workers who are not exposed to wood smoke and oil fumes in an occupational setting. All consenting mai suya and matched controls were recruited. Both groups underwent an interviewer administered questionnaire followed by on spot spirometric test measuring forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR). Results are presented using descriptive statistics. Chi square was used to test for association between respiratory symptoms and the job categories. Student's t-test was used to compare values of continuous variables. Odd ratios were determined for the risk of respiratory symptoms and exposure to wood smoke and oil fumes. RESULTS: Both groups are similar in their demographic characters except in their smoking status, so current smokers were excluded from further analysis. The test group had significantly increased occurrence of chest tightness: 59% (19/32), nasal congestion: 37% (12/32), cough: 32% (10/32), and wheeze: 12% (4/32) compared with the control group, odds ratio (OR) 3.1, 95% confidence interval CI (0.1-5.8), P value 0.04, OR 1.2,95% CI (1.04-1.8), P value = 0.02, OR 0.9 95% CI (0.9-1.4), P value = 0.3, and OR 1.2,95% CI (1-1.3), P value = 0.04, respectively. Occurrences of some respiratory symptoms were associated with duration on the job, while a positive family history of asthma is not associated with increased occurrence of symptoms. The mean (SD) FEV1 and FVC were significantly lower among the test group compared with the control group; 2.5L/s (0.55) versus 3.02L/s (0.51), P value = 0.007 and 2.7L (0.7) versus 3.16L (0.51), P value = 0.04. CONCLUSION: Mai suya' have increased risk of respiratory symptoms and altered pulmonary functions. There is a need for protective equipment and periodic evaluation.

Factors affecting interest in respiratory medicine as a subspecialty of choice: survey of internal medicine residents in Nigeria.

AIMS AND OBJECTIVES: The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. RESULTS: Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. CONCLUSION: The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.

Willingness of Nigerians to donate a kidney.

BACKGROUND: Kidney transplantation is a popular modality of RRT in the developed world. OBJECTIVE: To assess the willingness of the general population of Nigerians across the country to donate a kidney METHODS: This is a multiregional, cross sectional, questionnaire based study. One thousand Three hundred respondents participated in the study. This study was carried out in four major Towns and cities across Nigeria between January 2009 and December 2010. The locations are Birnin Kebbi in the north, Ilorin in the middle belt, Iddo Ekiti in the south and Lagos, the economic capital of Nigeria. The respondents were randomly selected within the four localities. Those below the age of 16 or above the age of 65 years were excluded from the study RESULTS: There were 727 (55.9%) males. The mean age (S.D) of respondents was 39.5 (10.7) years. The largest population of participants, 494 (38.3%) were non health workers and 692 (53.2%) of them were Muslims. Eight hundred and fifty eight (66%) of the participants were willing to donate a kidney. Twenty five percent (25% were not willing and 115 (8.9%) were not sure. Majority of those who were unwilling to donate a kidney, 325 (99.4%) will not change their minds even if they were to be given incentives CONCLUSION: Nigerians are willing to donate a kidney irrespective of geographical location, religion or gender and many are willing to do so altruistically.

Profile and outcome of unilateral tuberculous lung destruction in Ilorin, Nigeria.

BACKGROUND: Unilateral tuberculous lung destruction is a serious chronically disabling and often fatal complication of pulmonary tuberculosis. A few previous studies have dealt with some aspects of this entity among Nigerians with pulmonary tuberculosis but these studies may not truly reflect its current trends. OBJECTIVE: To describe the presenting profiles and outcome of unilateral tuberculous lung destruction among patients with pulmonary tuberculosis. METHODS: The study was a chart review of the medical records of adult patients with pulmonary tuberculosis complicated by unilateral lung destruction seen between January 1999- December 2008. Data extracted included demographic, and outcome of treatment. The clinical features, sputum results and illustrative cases are presented. RESULTS: Unilateral lung destruction complicated 74(1.3%) of 5,926 pulmonary tuberculosis cases seen over the review period. Most cases occurred in males [45(60.8%)] and they were predominantly [51(68.9%)] below 40 years of age. Most of them [52(70.2%)] presented after six months of symptoms. Forty-seven (63.5%) of them had had previous exposure to antituberculosis drugs. The left lung was affected in 49 (66.2%) patients. Only 25 (33.8%) of them were cured while the adjusted mortality rate was 25.5%. Male gender, presence of dyspnoea on mild exertion and right ventricular failure were significantly associated with increased mortality. CONCLUSION: Unilateral tuberculous lung destruction has unacceptably high mortality rate which can be prevented by patient presenting early to the hospital, prompt diagnosis and strict adherence to the standard treatment.