Periodontal Diseases in Adult and Elderly Nigerians: A National Survey.

BACKGROUND: Periodontitis has been shown to have links with general health and increase the risk of complications of some systemic diseases now showing a rising prevalence with age. The rising proportion of the elderly globally, and a high prevalence of periodontal disease among older adults may significantly impact the need for oral health care services in the near future. This national survey was carried out to highlight the trend of periodontal diseases among adult and elderly Nigerians and make evidence-based recommendations for good management outcomes. MATERIALS AND METHODS: A national cross-sectional survey of periodontal diseases (using the CPITN Index) among adult (35-44-year-old) and elderly (65-74-year-old) Nigerians selected by multistage sampling method. RESULTS: Periodontal disease is prevalent among adults (96.5%) and elderly (97.6%) Nigerians, with the zonal prevalence approximating the national prevalence. Gingivitis is the prevalent periodontal disease type in these age groups, with a national prevalence of 86.8%, 67.6% respectively, and more in the South than the North for both adults (90.7%, 83%) and elderly (75.7%, 59.7%), respectively (p<0.005). Destructive Periodontitis prevalence in adult and elderly Nigerians is 9.5%, 29.9%, respectively (p<0.05), with the North being more affected than South for both adults (13.4%, 5.6%) and elderly (37%, 22.7%), respectively (p<0.05). There is also a significant rise in the occurrence of destructive periodontitis with age, nationally and in all the zones (p<0.05). CONCLUSION: There is a high prevalence of periodontal diseases in adult and elderly Nigerians. The outcome of the management of periodontal diseases in adults and the elderly is inter-dependent on best practices in both oral and general health care service provision.

CONTEXTE: La parodontite a été liée à la santé générale et à l'augmentation du risque de complications de certaines maladies systémiques, montrant maintenant une prévalence croissante avec l'âge. La proportion croissante de personnes âgées dans le monde et une prévalence élevée des maladies parodontales chez les personnes âgées pourraient avoir un impact significatif sur le besoin de services de santé bucco-dentaire dans un avenir proche. Cette enquête nationale a été réalisée pour mettre en évidence la tendance des maladies parodontales chez les adultes et les personnes âgées nigérianes et formuler des recommandations fondées sur des preuves pour de bons résultats en matière de gestion. MATÉRIEL ET MÉTHODES: Une enquête nationale transversale sur les maladies parodontales (utilisant l'indice CPITN) parmi les adultes (35-44 ans) et les personnes âgées (65-74 ans) nigérianes sélectionnées par méthode d'échantillonnage à plusieurs niveaux. RÉSULTATS: Les maladies parodontales sont prévalentes chez les adultes (96,5 %) et les personnes âgées (97,6 %) nigérianes, la prévalence zonale approchant la prévalence nationale. La gingivite est le type de maladie parodontale prédominant dans ces groupes d'âge, avec une prévalence nationale de 86,8 %, 67,6 % respectivement, et plus dans le Sud que dans le Nord pour les adultes (90,7 %, 83 %) et les personnes âgées (75,7 %, 59,7 %), respectivement (p<0,005). La prévalence de la parodontite destructrice chez les adultes et les personnes âgées nigérianes est de 9,5 %, 29,9 %, respectivement (p<0,05), le Nord étant plus touché que le Sud pour les adultes (13,4 %, 5,6 %) et les personnes âgées (37 %, 22,7 %), respectivement (p<0,05). On observe également une augmentation significative de l'occurrence de la parodontite destructive avec l'âge, nationalement et dans toutes les zones (p<0,05). CONCLUSION: Il existe une prévalence élevée des maladies parodontales chez les adultes et les personnes âgées nigérianes. Les résultats de la gestion des maladies parodontales chez les adultes et les personnes âgées dépendent des meilleures pratiques dans la prestation de services de santé bucco-dentaire et générale. MOTS CLÉS: Prévalence, Gingivite, Parodontite, Nationale, Enquête.

Prevalence of Complete Edentulism in Adults and Older Nigerian Population.

INTRODUCTION: The prevalence of complete edentulism varies from country to country and from one region to another region, and making comparisons between national data challenging because of the impact of lifestyle, socio-economic and educational factors. There is no reported national data for Nigeria. AIMS AND OBJECTIVES: The study was to determine the prevalence of complete edentulism among adult (35-44 years) and older (65-74 years) Nigerians, being part of a national oral health survey of Nigerians conducted in 2014. METHODOLOGY: The study was a cross-sectional survey of oral diseases, specifically dental caries, periodontal diseases, dental trauma, and tooth loss, among adult and older Nigerian populations using a multi-stage stratified sampling technique for all 36 states and the FCT, and clinical examination in field situations using daylight settings, with findings collected using data entry forms (WHO 1997). Ethical approvals were obtained from the FMOH, SMOH and SMLGCA. Data was analysed using SPSS-11 and nominal variables compared using chi-square. A p-value of 0.05 was considered significant. RESULTS: A total of 5,038 adults and 4,658 older Nigerians were examined, of which 4(0.08%) and 84 (1.8%), respectively had complete edentulism. Among the adults, it was reported exclusively in Northern Nigeria; whereas among the older population, 66(2.8%) and 18(0.8%) participants in Northern and Southern Nigeria respectively, were reported to be edentulous (p<0.05). 45 cases (4.7%) of edentulism in older Nigerians were reported from the North West geopolitical zone alone. Edentulism is higher in the older population than the adult population in both Northern and Southern regions (p<0.05). Socio-demographic variation was significant in the North, with a higher prevalence in the rural localities among the older population (p<0.05). CONCLUSION: The study showed that there are variations in the prevalence of edentulism in Nigeria, reflecting lower prevalence in comparison with global trends. National prevalence values did not reflect variations along geographical and socio-political divide.

INTRODUCTION: La prévalence de l'édentation complète varie d'un pays à l'autre et d'une région à l'autre, ce qui rend les comparaisons entre les données nationales difficiles en raison de l'impact des facteurs liés au mode de vie, à la situation socio- économique et à l'éducation. Il n'existe pas de données nationales pour le Nigéria. BUTS ET OBJECTIFS: L'étude visait à déterminer la prévalence de l'édentation complète chez les Nigérians adultes (35-44 ans) et plus âgés (65-74 ans), dans le cadre d'une enquête nationale sur la santé bucco-dentaire des Nigérians menée en 2014. MÉTHODOLOGIES: L'étude était une enquête transversale sur les maladies bucco-dentaires, en particulier les caries dentaires, les maladies parodontales, les traumatismes dentaires et la perte de dents, parmi les populations nigérianes adultes et âgées, en utilisant une technique d'échantillonnage stratifiée à plusieurs niveaux pour les 36 États et le FCT, et un examen clinique dans des situations de terrain utilisant des environnements de lumière du jour, avec des résultats recueillis à l'aide de formulaires de saisie de données (OMS 1997). Les autorisations éthiques ont été obtenues auprès de la FMOH, de la SMOH et de la SMLGCA. Les données ont été analysées à l'aide du logiciel SPSS -11 et les variables nominales ont été comparées à l'aide du chi-carré. Une valeur p de 0,05 a été considérée comme significative. RÉSULTATS: Au total, 5 038 adultes et 4 658 Nigérians âgés ont été examinés, dont 4 (0,08 %) et 84 (1,8 %), respectivement, souffraient d'édentation complète. Chez les adultes, l'édentation a été signalée exclusivement dans le nord du Nigeria, tandis que chez les personnes âgées, 66 (2,8 %) et 18 (0,8 %) participants du nord et du sud du Nigeria respectivement ont été déclarés édentés (p<0,05). 45 cas (4,7%) d'édentulisme chez des Nigérians âgés ont été signalés dans la seule zone géopolitique du Nord-Ouest. L'édentulisme est plus élevé dans la population âgée que dans la population adulte, tant dans les régions du Nord que du Sud (p<0,05). Les variations sociodémographiques étaient significatives dans le Nord, avec une prévalence plus élevée dans les localités rurales parmi la population âgée (p<0,05). CONCLUSION: L'étude a montré qu'il existe des variations dans la prévalence de l'édentation au Nigéria, reflétant une prévalence plus faible par rapport aux tendances mondiales. Les valeurs de prévalence nationale ne reflètent pas les variations géographiques et sociopolitiques. Mots-clés: Édentulisme, Prévalence, Adultes, Personnes âgées, Nigérians.

Community Pharmacists, Pharmacy Counter Assistants and Oral Health Promotion in Plateau State, Nigeria.

OBJECTIVE: The involvement of community pharmacists (CPs) in oral health promotion is increasingly recognized and encouraged. However, a large proportion of interactions in community pharmacies take place with pharmacy counter assistants (PCAs) rather than the pharmacist. The study aimed to compare the knowledge and dispositions of PCAs and CPs in Plateau State, Nigeria, towards oral health. METHODS: A cross-sectional study of community pharmacies in the state. PCAs (n=164) and CPs (n=119) were involved in the study. The PCAs and CPs were given a questionnaire containing 24-items on knowledge of oral health and other variables. One sample and independent sample t-tests were used to assess knowledge scores and mean differences between knowledge scores of PCAs and CPs. RESULTS: The knowledge scores for CPs were between 11- 21, mean of 17.27±2.44. PCAs had a range of 6-21, mean of 16.05±2.56. Two PCAs had poor knowledge. Taking 16 (out of 24) as the minimum pass score, a one-sample t-test showed good knowledge for CPs: M=17.2, SD=2.44, t(118)=5.67, p<.001 but not PCAs M=16.1, SD=2.56, t(163)=.244, p=.808. Also, there was a statistically significant difference between the mean knowledge score of CPs and PCAs t(281) = -4.06, p<.001. Nearly all the CPs (93.9%) and the PCAs (96.3%) were willing to serve as oral health agents. CONCLUSION: PCAs are not as knowledgeable as CPs on oral health in Plateau state though they both perceived a role for themselves in promoting oral health. Their disposition towards oral health could serve as a platform to help propagate oral health care and awareness in their communities.

OBJECTIF: L'implication des pharmaciens communautaires (CP) dans la promotion de la santé bucco-dentaire est de plus en plus reconnue et encouragée. Cependant, une grande partie des interactions dans les pharmacies communautaires ont lieu avec les préposés au comptoir de pharmacie (PCA) plutôt qu'avec le pharmacien. L'étude visait à comparer les connaissances et les dispositions des PCA et des CP dans l'État du Plateau, au Nigéria, en matière de santé bucco-dentaire. MÉTHODES: Une étude transversale des pharmacies communautaires de l'État. Les PCA (n=164) et les CP (n=119) ont été impliqués dans l'étude. Les PCA et les CP ont reçu un questionnaire contenant 24 éléments sur la connaissance de la santé bucco-dentaire et d'autres variables. Des tests t pour un échantillon et un échantillon indépendant ont été utilisés pour évaluer les scores de connaissances et les différences moyennes entre les scores de connaissances des PCA et des CP. RÉSULTATS: Les scores de connaissance pour les CP étaient compris entre 11 et 21, moyenne de 17,27 ± 2,44. Les PCA avaient une fourchette de 6 à 21, une moyenne de 16,05 ± 2,56. Deux APC avaient une mauvaise connaissance. En prenant 16 (sur 24) comme score de réussite minimum, un test t sur un échantillon a montré une bonne connaissance des CP : M=17.2, SD=2.44, t(118)=5.67, p<.001 mais pas les PCA M= 16,1, ÉT = 2,56, t (163) = 0,244, p = 0,808. De plus, il y avait une différence statistiquement significative entre le score de connaissance moyen des PC et des PCA t(281) = -4,06, p<0,001. Presque tous les CP (93,9 %) et les PCA (96,3 %) étaient prêts à servir d'agents de santé bucco-dentaire. CONCLUSION: Les PCA ne sont pas aussi bien informés que les CP sur la santé bucco-dentaire dans l'État du Plateau, bien qu'ils aient tous deux perçu un rôle pour eux-mêmes dans la promotion de la santé bucco-dentaire. Leur disposition envers la santé bucco-dentaire pourrait servir de plate-forme pour aider à propager les soins de santé bucco-dentaire et la sensibilisation dans leurs communautés. MOTS-CLÉS: Santé bucco-dentaire, pharmaciens, préposés au comptoir en pharmacie.

Dental Trauma in Adult and Elderly Nigerians: A National Survey.

BACKGROUND: Various studies on Traumatic Dental Injuries (TDI) have been carried out in different small localities and mostly among children and adolescents in Nigeria, but there has not been any national study to determine its prevalence. This national survey was carried out to understand the complexities of dental trauma epidemiology among adult and elderly Nigerians. MATERIAL AND METHODS: A national cross-sectional survey of TDI among adult and elderly Nigerians, following WHO recommendations. RESULTS: A total of 5,067 adults (35-44 years) and 4,680 elderly (65-74 years) Nigerians were examined, and the prevalence of dental trauma among the adult and elderly was 15.9 % and 22.1%, respectively. Gender comparison showed males were more affected than females in the North (p<0.05), while TDIs occurred more among females in Southern Nigeria (p<0.05). In Nigeria, Type 2 injuries were most prevalent among the adults and elderly (53.9% and 55.7%, respectively). Among the elderly, while Type 1 injuries were more common in the North, Type 2 injuries were more prevalent in Southern Nigeria (p<0.05). Types 3-10 injuries were more prevalent in the South (p<0.05). TDI 1,2 occurred more in the anterior teeth among adults (p<0.05) and in posterior teeth among the elderly, especially in Southern Nigeria (p<0.05); while TDI 3-10 affected mostly the anterior teeth in both age groups (p<0.05. CONCLUSIONS: The observed pattern of dental trauma among the adults and elderly Nigerians could reflect the diverse dietary and socio-cultural practices. Advocacy for prevention of, relevant education on, research into and improvement of access to treatments for dental trauma is recommended.

CONTEXTE: Diverses études sur les traumatismes dentaires (TDI) ont été menées dans différentes petites localités et principalement chez des enfants et des adolescents au Nigéria, mais aucune étude nationale n'a été menée pour déterminer sa prévalence. Cette enquête nationale a été menée pour comprendre les complexités de l'épidémiologie des traumatismes dentaires chez les Nigérians adultes et âgés. MATÉRIEL ET MÉTHODES: Une enquête nationale transversale sur le TDI parmi les Nigérians adultes et âgés, conformément aux recommandations de l'OMS. RÉSULTATS: Un total de 5 067 adultes (35 à 44 ans) et 4 680 personnes âgées (65 à 74 ans) Nigérians ont été examinés, et la prévalence des traumatismes dentaires chez les adultes et les personnes âgées était de 15,9% et 22,1%, respectivement. La comparaison entre les sexes a montré que les hommes étaient plus touchés que les femmes dans le Nord (p <0,05), tandis que les IDT se produisaient davantage chez les femmes du sud du Nigeria (p <0,05). Au Nigéria, les blessures de type 2 étaient les plus fréquentes chez les adultes et les personnes âgées (53,9% et 55,7%, respectivement). Chez les personnes âgées, alors que les blessures de type 1 étaient plus fréquentes dans le nord, les blessures de type 2 étaient plus fréquentes dans le sud du Nigéria (p <0,05). Les blessures de type 3 à 10 étaient plus fréquentes dans le Sud (p <0,05). Le TDI 1,2 s'est produit davantage dans les dents antérieures chez les adultes (p <0,05) et dans les dents postérieures chez les personnes âgées, en particulier dans le sud du Nigéria (p <0,05); tandis que le TDI 3-10 affectait principalement les dents antérieures dans les deux groupes d'âge (p <0,05). CONCLUSIONS: Le modèle observé de traumatisme dentaire chez les adultes et les Nigérians âgés pourrait refléter les diverses pratiques alimentaires et socioculturelles. Il est recommandé de plaider en faveur de la prévention, de l'éducation pertinente, de la recherche et de l'amélioration de l'accès aux traitements des traumatismes dentaires. MOTS CLÉS: Blessures dentaires traumatiques, types, dentaires, traumatismes, adultes, personnes âgées, Nigéria.

Investigating the evolving microstructure of lithium metal electrodes in 3D using X-ray computed tomography.

The growth of electrodeposited lithium microstructures on metallic lithium electrodes has prevented their use in rechargeable lithium batteries due to early performance degradation and safety implications. Understanding the evolution of lithium microstructures during battery operation is crucial for the development of an effective and safe rechargeable lithium-metal battery. This study employs both synchrotron and laboratory X-ray computed tomography to investigate the morphological evolution of the surface of metallic lithium electrodes during a single cell discharge and over numerous cycles, respectively. The formation of surface pits and the growth of mossy lithium deposits through the separator layer are characterised in three-dimensions. This has provided insight into the microstructural evolution of lithium-metal electrodes during rechargeable battery operation, and further understanding of the importance of separator architecture in mitigating lithium dendrite growth.

Laser-preparation of geometrically optimised samples for X-ray nano-CT.

A robust and versatile sample preparation technique for the fabrication of cylindrical pillars for imaging by X-ray nano-computed tomography (nano-CT) is presented. The procedure employs simple, cost-effective laser micro-machining coupled with focused-ion beam (FIB) milling, when required, to yield mechanically robust samples at the micrometre length-scale to match the field-of-view (FOV) for nano-CT imaging. A variety of energy and geological materials are exhibited as case studies, demonstrating the procedure can be applied to a variety of materials to provide geometrically optimised samples whose size and shape are tailored to the attenuation coefficients of the constituent phases. The procedure can be implemented for the bespoke preparation of pillars for both lab- and synchrotron-based X-ray nano-CT investigations of a wide range of samples.

Dental Practice; Human Immunodeficiency Virus Transmission and Occupational Risks: Views from a Teaching Hospital in Nigeria

Background: More than 40 oral manifestations of human immunodeficiency virus (HIV) infection have been recorded and between 70 and 90 of persons with HIV infection will have at least one oral manifestation at some time during the course of their disease. Oral health-care workers (OHCWs) are therefore; key players in the prevention and management of HIV-infection. Aim: The aim of this study was toassess the perceptions of the OHCWs from a Teaching Hospital in Nigeria toward HIV transmission in dental practice and occupational risk. Subjects and Methods: A cross-sectional study. A self-administered questionnaire was used for data collection. A total of 113 OHCWs comprising students; house officers; resident doctors; dental nurses and consultants participated. Analysis was by Statistical Package for the Social Sciences version 17 (SPSS Inc.; Chicago; IL; USA). Data analysis included descriptive statistics (frequency distribution and cross tabulation). Results: More than half 64/113 (56) of the respondents were in the age group 20-30 years and females 68/113 (60). Though 88 (100/113) of the respondents demonstrated a good knowledge about HIV transmission; 82/113 respondents (72) disagreed that the risk of HIV transmission in the dental clinic was very low. 82.4 (93/113) did not know that saliva contains anti-HIV activity while 46 (52/113) agreed that pure saliva does not contain the virus except when contaminated by blood. 86.7 (98/113) of the OHCWs disagreed that dental professionals have a lower risk of being infected with HIV compared with other health-care providers. Conclusion: The OHCWs studied manifested some inaccurate perception of occupational risks as regards HIV transmission in dental practice. This could lead to potential stigma and discrimination of people living with HIV/acquired immune deficiency syndrome and thus hindering efforts geared at curtailing the spread of the virus

Discriminatory attitudes towards patients with HIV/AIDS by dental professionals in Nigeria.

AIMS AND OBJECTIVES: The study sought to investigate whether there are discriminatory practices towards HIV/AIDS patients among dental professionals in Nigeria, how receptive are dental professionals and institutions to treating People Living With Aids (PLWA), and what underlying factors if any that may contribute to any discriminatory practices. METHODS AND MATERIALS: It was a cross-sectional study conducted in one randomly selected State in each of the six geo-political zones of Nigeria. Data collection was by self administered questionnaire. The questionnaire asked about demographic information, general knowledge of HIV/AIDS, adequacy of infection control, fear of occupational exposure, attitudes towards HIV positive patients and areas of need for further training. A total of 75 dental professionals participated in the study. RESULTS: The results of the study suggest that significant number of dental professionals in Nigeria reported attitudes and behaviour towards HIV patients which are discriminatory. CONCLUSION: Further efforts should be made to promote accessibility of discrimination-free quality oral and dental care to this population.

Oral manifestation of HIV/AIDS in Plateau state indigenes, Nigeria.

BACKGROUND: To investigate the prevalence of oral manifestations of HIV/AIDS involving HIV positive Plateau State indigenous adults attending a Special Treatment Clinic serving referred cases and in-patient cases hospitalized in the Medical wards in JUTH, Jos. STUDY DESIGN: A cross-sectional study. RESULTS: A total of 261 patients confirmed for HIV infection were examined. The age range was 17 - 80 years, mean = 35.6 +/- 9.27 (SD). 59.4% were females and 40.6% were males. Oral lesions attributable to HIV/ AIDS infection were found in 109 (41.8%) patients, 38 (34.9%) of these patients had multiple lesions. Oral lesions were diagnosed more frequently in women (59.6%) than in men (p=0.945). Oral candidiasis was the most common presentation (35.7%) with pseudomembraneous candidiasis (23%) and angular cheilitis (10%) being the most common variants. All the cases of erythematous candidiasis (n=7) were exclusively seen in the female population. Oral hairy leukoplakia and xerostomia were present in 4.6% and 3.8% of cases respectively. Kaposi's Sarcoma was in 5 (1.9%) patients. CONCLUSION: The prevalence of HIV-related oral lesions (HIV-ROL) in a hospital based adult population of Plateau State indigenes in Jos is 41.8%. Oral Candidiasis is the most common HIV-ROL detected and this agrees with most reported findings.

Prevalence of HIV--related oral lesions in Nigerian women.

BACKGROUND: Human immunodeficiency virus (HIV) infection affects an increasing number of women throughout the world. Oral lesions are among the earliest clinical manifestations of HIV infection and are associated with its progression. We describe the oral manifestations of HIV/AIDS in Nigerian women and its clinical correlates. METHODS: Nigerian women with HIV/AIDS were examined for the presence of oral lesions attributable to HIV/AIDS. These lesions were diagnosed clinically, according to the criteria established by the European Community Clearinghouse (ECC) on oral problems related to HIV infection. RESULTS: Two hundred and sixty-nine seropositive women were examined with a range of 17-60 years (mean of 32.4 years < 8.09). The age group of 21 30 years was the worst affected (n = 125, 46.5%). Of these patients, 109 (40.5%) were married, 67 (24.9%) were single while 47 (17.5%) had multiple sexual partners. One hundred and eighteen (43.9%) had at least an oral lesion associated with HIV/AIDS. The most common was oral candidiasis, which was present in 98 (36.4%) patients. Pseudomembraneous candidiasis (n = 66, 24.5%) and angular cheilitis (n = 23, 8.6%) were the commonest variants seen. The former was the only lesion significantly associated with the clinical stage of the infection (p = 0.002) while necrotizing gingivitis, linear gingival erythema and angular cheilitis were associated with the age of the patients (p < 0.05). CONCLUSION: Oral manifestations are common features of HIV infection among Nigerian women. Oral candidiasis (OC) was the most notable oral lesion associated with HIV/AIDS. It may be a useful clinical indicator of early immune dysfunction mediated by HIV.

Energy intakes, anthropometry and body composition of Nigerian adolescent girls: a case study of an institutionalized secondary school in Ibadan.

Twenty-two apparently healthy Nigerian adolescent girls aged 11-17 years residing in a hostel, were studied over five consecutive days in order to assess their energy intake (EI), energy cost of specific activities and body composition (BC). The mean characteristics of the group were: height 1.58 (SD 0.1, range 1.42-1.68) m, body weight 49.1 (SD 7.9, range 34.0-61.0) kg and BMI 19.5 (SD 2.0, range 16.0-23.0) kg/m2. The food intake of each subject was assessed by direct weighing and its energy value was determined by means of a ballistic bomb calorimeter. BMR values were calculated according to Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) (1985) equations. Percentage body fat (BF%) values were derived from three skinfold thickness measurements, using population-specific equations. The adolescents' mean daily EI was found to be 6510 (SD 855) kJ/d (138.3 (SD 27.8) kJ/kg body weight per d) which is lower than the FAO/WHO/UNU (1985) calculated energy requirement of 8800 kJ/d for adolescent girls aged 12-14 years. The contributions of specific nutrients and individual meals to the total EI were: carbohydrate, protein and fat, 59.2, 12.5 and 28.3% of energy respectively and breakfast, lunch and supper, 21.5, 41.0 and 37.4% respectively. However, the mean BMR was 5627 kJ/d, which is comparable with that given by FAO/WHO/UNU (1985) for adolescent girls aged 13-14 years. The mean BF% was found to be 21.7. The comparatively low EI of the participants in the present study may be indicative of energy deficiency in their meals. This assumption is also reflected in their BC values. Nevertheless, further studies of this kind on adolescents in Nigeria are needed to confirm these observations.

Spontaneous versus edrophonium-induced recovery from paralysis with mivacurium.

This study compared spontaneous with edrophonium-induced recovery of neuromuscular transmission (NMT) after mivacurium infusion. During nitrous oxide-narcotic-propofol anesthesia, the electromyogram (EMG) of the adductor pollicis (AP) was recorded and the movement of the first toe in response to stimulation of the posterior tibial nerve was noted. Mivacurium infusion was titrated to produce posttetanic count of 1-5 at the toe and absence of NMT at the AP. Thirty children were assigned to three groups on the basis of age. Edrophonium, 1 mg/kg, with atropine 10 micrograms/kg, was given after the mivacurium infusion when NMT of the AP was 1% or 10% of baseline. In the third group, spontaneous recovery was observed. Edrophonium given when NMT was 11% +/- 1% SEM produced the most rapid recovery, 7.5 +/- 0.6 min to a train-of-four (TOF) ratio (T4/T1) of 0.9 and the shortest interval from T4/T1 of 0.4-0.9, when residual block was likely to be underestimated, 4.8 +/- 0.6 min. Edrophonium given when block was greater produced recovery of the T4/T1 to 0.4 in 2.8 +/- 0.7 min, but the time from then to T4/T1 = 0.9 was 7.9 +/- 1.1 min, as long as during spontaneous recovery. Spontaneous recovery to T4/T1 = 0.9 occurred 12.9 +/- 0.7 min after the first measurable AP EMG. There was no significant relationship between duration of infusion, which ranged from 16 to 135 min, and time to appearance of AP EMG after the infusion, which averaged 3.1 +/- 0.5 min. We recommend that administration of edrophonium to induce reversal of mivacurium be delayed until two responses to a TOF stimuli are observed because this will produce the most rapid recovery and decrease the interval in which residual block may be underestimated.

Plasma biochemical parameters in Nigerian children with protein energy malnutrition.

Eleven plasma biochemical parameters were estimated in a total of 28 children with protein-energy malnutrition (PEM): 7 children each category of marasmus, kwashiorkor, marasmic-kwashiorkor and undernutrition with ages between 8 and 48 months. The estimations were performed on admission and 8 to 24 days after treatment at the Obafemi Awolowo University Teaching Hospitals Complex, Nigeria. Plasma sodium, potassium, chloride, bicarbonate and albumin levels were significantly (p < 0.05) higher after treatment than on admission. Calcium however, showed no significant change. Total protein and cholesterol were significantly (p < 0.05) raised after treatment for all the PEM types except undernutrition and kwashiorkor respectively. Globulin, urea and creatinine were significantly (p < 0.05) raised after treatment for kwashiorkor. These biochemical findings support the claims of clinical improvement in PEM children after a minimum of 18 days of treatment at the OAUTHC in Nigeria.

PIP: 11 plasma biochemical parameters were estimated in 28 children aged between 8 and 48 months with protein-energy malnutrition (PEM): 7 children each in the categories of marasmus, kwashiorkor, marasmic-kwashiorkor, and undernutrition. 8 ml of blood was obtained from each of the 7 children with marasmus, kwashiorkor, marasmic-kwashiorkor, and undernutrition, respectively, on admission to the children's ward of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, and put into lithium heparinized tubes. The children were hospitalized for 18 and 24 days and fed the diet for PEM in the OAUTHC. 8 ml of blood was again taken from the children just before they were discharged. The percentage of recovery weight ranged between 74.4 and 86.4. Analysis of variance showed significance (p 0.05) for all types of PEM for plasma sodium, bicarbonate, urea, total protein, albumin, and globulin. The levels of plasma electrolytes comprising potassium, sodium, chloride, and bicarbonate were significantly (p 0.05) higher after recovery for all 4 types of PEM. There was also a significant (p 0.05) increase in plasma albumin levels in all 4 types of PEM. Plasma total protein levels were significantly increased in all types of PEM except undernutrition. The plasma globulin fraction which contains immune elements for body defense may be more tenaciously retained in PEM than albumin and only kwashiorkor showed a significant (p 0.05) increase after treatment. Plasma urea levels were significantly (p 0.05) higher after treatment than before for marasmus and kwashiorkor, the most protein deficient states in PEM. Plasma creatinine levels after treatment were significantly (p 0.01) lower for marasmic-kwashiorkor after treatment than on admission. The observed rise in kwashiorkor may reflect the increase in muscle formation and activity, while its decrease in marasmic-kwashiorkor possibly reflects increased renal function and efficiency.

Pleural empyema in infants and children: analysis of 298 cases.

Of 298 infants and children with empyema thoracis seen, 62 percent were under 2 years of age. The majority of the cases had underlying pulmonary infection, and Staphylococcus aureus was dominant among the organisms isolated. The diagnosis was made in all cases on the basis of chest x-ray films and thoracentesis. Full expansion of the lung and resolution of the underlying pneumonia occurred on administration of appropriate antibiotics and catheter drainage in all cases except in two patients who had decortication. The mortality rate was 5 percent; delayed presentation and suboptimal prehospitalization antibiotics influenced the morbidity.