Impact of Seasonal Changes on Asthma Control in North-Western Nigeria.

BACKGROUND: Asthma control is poor worldwide and is often affected by changes in environmental conditions. Effort to determine the cause of this heavy burden on patients and the healthcare system is crucial. AIM: To determine the role of seasonal changes on asthma control in Sokoto, North-Western Nigeria. METHODS: One hundred and one (101) patients with physician diagnosed asthma were consecutively recruited after obtaining informed consent. A structured researcher administered questionnaire was used as instrument of data collection and asthma control test questionnaire was also used to assess level of asthma control in each participant. Five items with a 4-week recall were assessed. Data for temperature, humidity, wind and rain was obtained from the Nigerian Meteorological Agency (NIMET), Sokoto. We computed frequency and level of asthma control with seasons of the year and weather variables. RESULTS: One hundred and one patients comprising 71 females and 30 males with a mean age of 32.14 ± 10.68 years participated in the study. Level of asthma control was found to be poor among the participants with 41(40.6%) having very poorly controlled asthma, 30(29.7%) with not well controlled and 30(24.8%) well controlled asthma respectively. Among patients with very poorly controlled asthma, 22(48.9%) occurred during harmattan season and 14(31.1%) during rainy season. Weather parameters such as humidity shows significant relationship with asthma control (B= -0.504, P= 0.031, 95% CI [-0.012, -0.0253]). CONCLUSION: The study shows that asthma control is poor among the participants and presentation with poor asthma control is more during harmattan season.

CONTEXTE: Le contrôle de l'asthme est médiocre dans le monde entier et est souvent affecté par les changements des conditions environnementales. L'effort pour déterminer la cause de ce lourd fardeau pour les patients et le système de santé est crucial. OBJECTIF: Déterminer le rôle des changements saisonniers sur le contrôle de l'asthme à Sokoto, dans le nord-ouest du Nigeria. MÉTHODES: Cent un (101) patients atteints d'asthme diagnostiqué par un médecin ont été recrutés de manière consécutive après avoir obtenu leur consentement éclairé. Un questionnaire structuré administré par le chercheur a été utilisé comme instrument de collecte de données et le questionnaire de test de contrôle de l'asthme a également été utilisé pour évaluer le niveau de contrôle de l'asthme chez chaque participant. Cinq éléments avec une période de rappel de 4 semaines ont été évalués. Les données sur la température, l'humidité, le vent et la pluie ont été obtenues auprès de l'Agence météorologique nigériane (NIMET) de Sokoto. Nous avons calculé la fréquence et le niveau de contrôle de l'asthme en fonction des saisons de l'année et des variables météorologiques. RÉSULTATS: Cent un patients, comprenant 71 femmes et 30 hommes, avec un âge moyen de 32,14 ± 10,68 ans, ont participé à l'étude. Le niveau de contrôle de l'asthme s'est avéré médiocre parmi les participants, avec 41 (40,6 %) ayant un asthme très mal contrôlé, 30 (29,7 %) un asthme non bien contrôlé et 30 (24,8 %) un asthme bien contrôlé, respectivement. Parmi les patients souffrant d'asthme très mal contrôlé, 22 (48,9 %) ont été signalés pendant la saison de l'harmattan et 14 (31,1 %) pendant la saison des pluies. Les paramètres météorologiques tels que l'humidité montrent une relation significative avec le contrôle de l'asthme (B= -0,504, P=0,031, IC à 95 % [-0,012, -0,0253]). CONCLUSION: L'étude montre que le contrôle de l'asthme est médiocre parmi les participants et que les cas d'asthme mal contrôlé sont plus fréquents pendant la saison de l'harmattan. MOTS-CLÉS: Asthme, Contrôle de l'asthme, Saison, Harmattan.

In ovo injection of black cumin (Nigella sativa) extract on hatching and post hatch performance of thermally challenged broiler chickens during incubation.

The objective of this study was to investigate the effects in ovo injection of black cumin (BC) extract on chick's quality and response of thermally challenged broiler chickens. A total of 700 hatching eggs of broiler chickens (Marshall) were assigned to 7 treatments of 100 eggs each and incubated using the conventional protocol (37.8°C) for the first 10 d and then exposed to a high temperature (39.6°C) for 6 h daily from day 10 until day 18 of the incubation. At embryonic day 17.5, the eggs were randomly allotted to 7 treatment groups, viz.: eggs without in ovo injection (WA), eggs injected with 0.9% saline solution (SA), 3 mg ascorbic acid (AA), 2 mg BC (TB), 4 mg BC (FB), 6 mg BC (SB), and 8 mg BC (EB) extracts. Experiment was laid out in a Completely Randomized Design. After hatching, the chicks were reared separately according to in ovo treatments for 8 wk. Data were collected on hatchability, chick quality, internal organs, growth performance, plasma superoxide dismutase, malondialdehyde, and triiodothyronine (T3). The results showed that the hatchability of the eggs in the AA group was similar to that of SB eggs and higher than that of the other treatment groups. The intestinal weights of SB and EB birds were significantly higher (P < 0.05) than those of TB, SA, and WA. The final weights of the birds of SB and AA were higher (P < 0.05) than those of other treatments. The feed conversion ratio of the birds of TB and FB was comparable to that of EB and WA but higher than that of SB and AA. At hatch, the creatinine of the birds in SA and WA was similar to that of EB, FB, and TB but higher (P < 0.05) than that of AA and SB. Also, the plasma malondialdehyde, T3, and superoxide dismutase of SB and AA birds were better (P < 0.05) than those of the control groups. Overall, it was concluded that 6 mg of BC extract improved the antioxidant status and posthatch performance of thermally challenged broiler chickens.

Clinical neuropathy in HIV/AIDS: an eight-year review of hospitalized patients in Sokoto, northwestern Nigeria.

HIV/AIDS is a multi-systemic disease that targets mainly the immune and nervous systems. Although about 4.4% of Nigerians are infected with HIV, data on the spectrum of HIV-related nervous disease in this population is rare. This study describes the neurological manifestations of HIV/AIDS in northern Nigeria. We undertook retrospective and descriptive analyses of the demographic, clinical, neurologic and laboratory data of all hospitalized HIV/AIDS adults in a referral hospital in northwestern Nigeria. The study period covered 2000 to 2007. We studied 322 HIV/AIDS patients (218 men, 104 women) aged 33.4 +/- 11.4 years (range: 18-65 years) who constituted 3.5% of the total medical admissions. HIV transmission was exclusively by heterosexual intercourse involving multiple partners. The majority (70.2%) was married and 78.9% were in stage III/IV HIV/AIDS disease. Fifty-two (16.2%) had CD4+ T-cell count determination, the mean value being 220 +/- 147.2 cells/m(3), and 58 (18.0%) were on highly active antiretroviral therapy. Fifty-one (15.8%) had neurological complications dominated by central nervous diseases including encephalitis (17.6%), dementia (16.2%) and stroke (14.9%). Peripheral nerve involvements were relatively infrequent. Compared with HIV/AIDS patients without neurological complications, a significantly higher proportion of those with HIV-associated neuropathy had a stage IV disease (30% versus 9.4%, chi(2) = 19.5, P < 0.001). Neurological complications, particularly central nervous diseases, are an important cause of morbidity in the HIV/AIDS population.

An audit of snake bite injuries seen at the Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria.

BACKGROUND AND OBJECTIVES: Snakebite is an important but often overlooked medical problem worldwide. This work is an audit of snakebite injuries in Sokoto, North West Nigeria using hospital-based data. METHODOLOGY: A retrospective analysis of the records of all adult patients with snakebite managed at Usmanu Danfodiyo University Teaching Hospital Sokoto, North West Nigeria from January 2000 to December 2004 was carried out. Information retrieved included demographic and clinical data. RESULTS: Seventy three patients made up of 55 males (75.3%) and 18 females (24.7%) were involved. Male to female ratio was 3:1. Snakebite constituted 1.7 per 1000 hospital admissions and 12.7 per 1000 medical admissions. 82.2% of the patients were between 15 and 40 years of age. 89% of the bites were between the months of March and October. 54.8% of the patients were bitten in the home environment while 39.7% were bitten in the bush. The lower limbs were the most common sites of bite (58.9%). Most( 63%) of the bites occurred during the daytime. 50.7% of the patients showed signs of envenomation while 64.4% received antivenom. Majority of the patients survived and 2.7% of the patients died. The outcome was unknown in 26.0% of patients. CONCLUSION: Snakebite constitutes an important cause of hospital admission and occurs mainly during the rainy season which coincides with the period of intense farming activities in the study population. The build up commences during the period of intense heat. Envenomation status of patients need to be accurately determined to avoid excessive use of antivenoms with the attendant risk to patients.

The effect of cement dust exposure on haematological and liver function parameters of cement factory workers in Sokoto, Nigeria.

This study measured haematological and liver function parameters in workers occupationally exposed to cement dust in order to test the hypothesis that cement dust exposure may perturb these functions. Assessment of haematological parameters and liver function were performed in 23 workers occupationally exposed to cement dust (mean years of exposure 9.6+/- 1.5 years) and 46 matched unexposed controls. The haemoglobin concentration (P < 0.001) and packed cell volume (P < 0.02) of exposed workers were significantly lower and the platelet (P < 0.01) and white cell counts (P < 0.05) were significantly higher than in the unexposed workers. There was no significant difference in the total granulocyte and lymphocyte/monocyte counts. The liver function parameters remained similar in the exposed workers compared to the unexposed except serum aspartate aminotransferase and alkaline phosphatase activities which were significantly lower (P <0.05). These results suggest that occupational exposure to cement dust may perturb haemopoietic function while preserving liver function.

Perceptions of Medical Students Undergoing Cadaveric Training: a Sociocognitive Perspective

The emotional and sociocognitive aspects of human dissection are important aspects of professionalism in medical training and so should be critically evaluated in the present day changing society. Medical students of Ebonyi State University; Nigeria completed 390 questionnaires. The questionnaires included questions seeking demographic information; open-ended questions on their first experience of dissection and suggestions on improvements in training. The Visual analogue scale (VAS) was used to assess anxiety and satisfaction levels. The questionnaires were analyzed statistically with P0.05 indicating level of significance. Majority (35.7) of the students was excited/fulfilled after their first experience and 41.5were of the opinion that life in humans is more appreciated by dissection. Their mean anxiety level was 3.42 while satisfaction rating was 7.13 on a scale of 1-10. A greater number of students suggested that conducive learning environment and improved preservation techniques would improve satisfaction (30.3and 33.1respectively). A Conducive environment and better preservation of cadavers are the major factors that improve satisfaction. Psychosocial factors should be assessed constantly to ascertain attitudinal changes of students; which will be helpful in quality of professional formation

Comparative evaluation of active learning and the traditional lectures in physiology: a case study of 200 level medical laboratory students of Imo State Unversity, Owerri.

Currently, understanding of physiology and disease patterns is undergoing a fundamental paradigm shift with attendant shift in education of health professionals worldwide towards active learning to encourage exploration of connections and their relationships. We introduced problem-based learning to physiology teaching of medial laboratory students to confirm worldwide reports that active learning environments offer better learning opportunities over the traditional methods which is the predominant teaching method in Nigerian universities. Our findings indicate that problem-based learning increases students' attendance/participation in classes and performance in examination. We recommend the integration of active learning into physiology curriculum of Nigerian Universities.

Grades of gallbladder diseases using gallbladder contraction index: a pilot study.

The aim of this study was to develop a pilot model for the assessment of the severity of gallbladder diseases based on gallbladder contraction index, clinical and sonographic appearances of the gallbladder. The gallbladder contraction index (GBCI) was obtained as the average of the first ten and the first 20 minutes contraction indices. A range of 5% to 77% previously obtained in normal subjects was adopted in this study. Gallbladder contraction index in combination with other variables: sonographic appearances and clinical presentations were used for the grading of gallbladder diseases in the present study. This pilot model may have a good diagnostic performance but a clinical prospective evaluation is needed to confirm its actual value.

Incidence of occupational stress among medical radiographers: a population based zonal survey.

Biomechanical and psychosocial stresses are capable of destabilizing any health care professional. The current health sector reform in Nigeria, which lays emphasis on service delivery on a background of very few radiographers, may lead to an increase in stress level. This study investigated the incidence of occupational stress among radiographers in southeastern Nigeria. 50 self-completion questionnaires were delivered to radiographers in the southeastern Nigeria. The questionnaires included questions seeking information on the demographic profile of the radiographer, anatomical regions of biomechanical systems/stress and Visual Analogue Scale (VAS), which rated job satisfaction and anxiety levels. 32 questionnaires were returned and analyzed statistically. Biomechanical stress was observed in all anatomical regions studied. Job satisfaction rating was 61.3% and anxiety level was 45.3%. This study has provided a baseline stress level and prevalence among radiographers with which future studies in view of the on going health sector reform in Nigeria could be compared.

Management of asthma in adults: current trends and future directions.

Bronchial asthma has witnessed a significant increase in its prevalence in the past decade. Considerable morbidity and significant mortality has been associated with it and this has been matched by increased scientific research into new methods of therapy to supplement or replace the traditionally known treatment modalities. A search for old and new literature on asthma management in adults necessitated forage in the library for old works and an internet search into relevant websites to download several works on asthma from which those relevant to this article were selected. Evidences supporting current asthma therapies including some non-pharmacological measures of intervention and alternative approaches were highlighted. Some novel interventions that may be useful in the future management of asthma were discussed. Some novel therapeutic agents acting on specific components of the inflammatory pathways in asthma are emerging. The future management of asthma may involve the use of these newer agents in combination with more established therapies. For successful management of asthma, patient's education and involvement are essential.

Experiences in management of Pott's paraplegia and paraparesis in medical wards of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

BACKGROUND: Pott's disease refers to spinal tuberculosis, which commonly leads to a gradual onset of neurological deficit that are difficult to diagnose at the early stage. METHOD: The study was a combination of retrospective and prospective study. Information was obtained using a predesigned protocol. Diagnosis was based on clinical features and plain spinal x-ray. Anti-tuberculous therapy was instituted in all patients for a minimum of 18 months. Monitoring of neurological status was done weekly. RESULTS: There were 92 patients made up of 71 males (77.2%) and 21 females (22.8%) with a male: female ratios of 3.4:1. 53.3% were paraplegic while 46.7% were paraparetic. The age group 31-40 years was the most affected. 43.5% of the patients were farmers who formed the majority. Back pain, weight loss, paraplegia and paraparesis in that order were the common clinical features. 25% of the patients recovered full use of their lower limbs at the end of the study. Thoracic spine and lumbar spine were equally involved (41.5% respectively) while thoraco-lumbar spine was involved in 15.1% of patients. Cervical spine was only involved in 1.9% of the patients. CONCLUSION: Effective management of spinal tuberculosis should be a teamwork involving the physician, orthopedic surgeon, neurosurgeon as well as the radiologist. The rural populace needs to be educated to prevent late complications and ensure better prognosis.

Case Report: Acute Limb Ischaemia and Gangrene associated with Peripartum Cardiomyopathy.

UNLABELLED: Thromboembolic complications are frequent in patients with peripartum cardiomyopathy (PPCM). Peripheral artery occlusions are however rare. This case report describes a 30-year-old grand multiparous woman with PPCM complicated by acute lower limb ischaemia and gangrene. This followed left intraventricular thrombi despite maintenance of sinus rhythm. We suspect that the thrombosis is caused by the hypercoagulable state of peripartum period, ventricular dilatation and hypokinesis. The impacts of economic and sociocultural factors in the management of this rare complication of PPCM in a resource depleted nation are highlighted. KEYWORDS: peripartum cardiomyopathy, limb ischaemia.

Tuberculosis: current trends in diagnosis and treatment.

Among communicable diseases, tuberculosis (TB) is the second leading cause of death worldwide, killing nearly 2 million people each year. It is estimated that about one-third of the world population are infected with TB (2 billion people) and about 10% of this figure will progress to disease state. Most cases are in the less-developed countries of the world. Tuberculosis incidence has been on the increase in Africa, mainly as a result of the burden of HIV infection. Definitive diagnosis of tuberculosis remains based on culture for Mycobacterium tuberculosis, but rapid diagnosis of infectious tuberculosis by simple sputum smear for acid fast bacilli remains an important tool, as more rapid molecular techniques are being developed. Treatment with several drugs for 6 months or more can cure more than 95% of patients. Direct observation of treatment, a component of the recommended five-element DOTS strategy, is judged to be the standard of care by most authorities. Currently only a third of cases worldwide are treated using this approach. There may be need to modify the treatment modalities especially with the choice of drugs and duration of therapy when TB infection occurs in special situation like pregnancy, liver disease, renal failure or even in coexistence with HlV/AIDS or the drug resistant state.

Reference values for peak expiratory flow rate in adults of African descent.

Substantial racial differences in the values of peak expiratory flow (PEF) rate have been noted by several workers in the past. It has also been noted that applying prediction formulae derived from a Caucasian population overestimated the PEF values in Black Africans by 12%-15%. Yet reference values used up until the present, even among Black populations, are based on such formulae. This study provides new reference values for use in the Black population. They were obtained by using curvilinear formulae derived from the study of 1009 normal adult Nigerians (668 men and 341 women) between the ages of 15 years and 82 years, living and/or working in Port Harcourt, Nigeria and its hinterland.

Investigations of the methanolic leaf extract of Costus afer. Ker for pharmacological activities in vitro and in vivo.

The methanolic leaf extract of Costus afer. Ker (family: Zingiberaceae) was investigated for some pharmacological effects in vivo and in vitro. Brine shrimp lethality test showed that the extract was significantly (p < 0.05) cytotoxic with LC50 of 21.3 ppm. The extract showed moderate local anesthetic property, about twice less than lignocaine of the same concentration, on guinea pig wheal test. The extract contracted the guinea pig ileum in a concentration-dependent manner, but had no effect on pleuripara and nullipara non-gravid uteri at progestogenic and estrogenic phases respectively. The contractile effect on the guinea pig ileum was partially inhibited by atropine but completely reversed by adrenaline. The extract induced expulsion of whole fetuses still enveloped within the placental membrane at the 3rd trimester of pregnancy. The extract exhibited a biphasic antihyperglycemic activity. At 200 mg/kg body wt., p.o., it decreased the blood glucose level by 50% in Streptozotocin-induced hyperglycemia in male rats in 60 minutes post dosing. However, doses above 200 mg/kg body wt., p.o., caused increase in blood glucose level, potentiating the action of STZ. At 10 microg/ml the extract induced about 98% glucose uptake in differentiated 3T3-L1 adipocytes when compared with insulin (340 nm).

Experimental trypanosomiasis in Yankasa ewes: the body weight response.

Sleeping sickness (African Trypanosomasis) is an anthropozoonosis transmitted primarily by the tsetse fly. It is associated with a host of clinical indices ranging from fever, aneamia and anorexia to reproductive failures in man and his domestic animals. The main objective of this study is to appraise the responsiveness of the body weight as a clinical indicator of sleeping sickness in experimentally infected Yankasa ewes. Twelve mature Yankasa sheep (6 infected and 6 control ewes) were used in this study. Weekly body weights and daily rectal temperature were taken while blood samples for haematology were collected twice a week from all animals before and after the experimental infection. Undulating parasitaemia was observed, two days post infection and was sustained through out the study period of about fifty days in all the infected ewes. Decreased body weight was found to be very prominent in the infected animals. All the infected ewes progressively lost weight during the experiment with a decrease of about 17.9% of the original weights while the control ewes had increased by 4.2% at the end of the study period. The body weight is therefore a very sensitive parameter in the surveillance and management of Trypanosome infections especially in Yankasa ewes as experimental animal models.

Epidemiology of Sarcocystis neurona infections in domestic cats (Felis domesticus) and its association with equine protozoal myeloencephalitis (EPM) case farms and feral cats from a mobile spay and neuter clinic.

Equine protozoal myeloencephalitis (EPM) is a serious neurologic disease in the horse most commonly caused by Sarcocystis neurona. The domestic cat (Felis domesticus) is an intermediate host for S. neurona. In the present study, nine farms, known to have prior clinically diagnosed cases of EPM and a resident cat population were identified and sampled accordingly. In addition to the farm cats sampled, samples were also collected from a mobile spay and neuter clinic. Overall, serum samples were collected in 2001 from 310 cats, with samples including barn, feral and inside/outside cats. Of these 310 samples, 35 were from nine horse farms. Horse serum samples were also collected and traps were set for opossums at each of the farms. The S. neurona direct agglutination test (SAT) was used for both the horse and cat serum samples (1:25 dilution). Fourteen of 35 (40%) cats sampled from horse farms had circulating S. neurona agglutinating antibodies. Twenty-seven of the 275 (10%) cats from the spay/neuter clinic also had detectable S. neurona antibodies. Overall, 115 of 123 (93%) horses tested positive for anti-S. neurona antibodies, with each farm having greater than a 75% exposure rate among sampled horses. Twenty-one opossums were trapped on seven of the nine farms. Eleven opossums had Sarcocystis sp. sporocysts, six of them were identified as S. neurona sporocysts based on bioassays in gamma-interferon gene knockout mice with each opossum representing a different farm. Demonstration of S. neurona agglutinating antibodies in domestic and feral cats corroborates previous research demonstrating feral cats to be naturally infected, and also suggests that cats can be frequently infected with S. neurona and serve as one of several natural intermediate hosts for S. neurona.

Blood pressure control among hypertensives managed in a specialised health care setting in Nigeria.

In spite of the plethora of anti-hypertensives, hypertension remains an important cause of morbidity and mortality among Nigerian hypertensive population. To determine blood pressure control rate, defined as the proportion of treated hypertensive population with systolic and diastolic blood pressures less than 140 mmHg and 90 mmHg respec tively. One hundred and ten (110) treated adult Nigerian hypertensives aged 28-80 (mean 46.02 +/- 15.20) years with male: female ratio of 1:1.4 who have been commenced on treatment for at least 6 months were selected by simple random sampling for determination of blood pressure control rate and its determinant factors using clinic blood pressures. Blood pressure control rate was 42.70%. Pre-treatment mean blood pressure was significantly higher than the value at least 6 months post commencement of treatment: (170.09 +/- 15.20/108.98 +/- 15.85 mmHg versus 146.10 +/- 24.50/93.8 +/- 21.90 mmHg) (t=8.73; p<0.05). In the group with uncontrolled blood +/- 17.91 mmHg in 42 (66.6%), rose by 10.50 +/- 1.0 mmHg in 8 (12.70%) and was unchanged in 13 (20.66%) patients. Diastolic blood pressure fell by 22.22 +/- 14.58 mmHg in 32 (50.8%), rose by 7.88 +/- 6.66 mmHg in 16 (25.40%) and was unchanged in 15 (23.80%) patients. Clinic compliance and family history of hypertension were associated with satisfactory blood pressure control. Blood pressure control rate among the study population was low. Compliance and family re-enforcement should be encouraged.