Project OPUS: Development and evaluation of an electronic platform for pain management education of medical undergraduates in resource-limited settings.

INTRODUCTION: Pain is a very frequent symptom that is reported by patients when they present to health professionals but remains undertreated or untreated, particularly in low-resource settings including Nigeria. Lack of training in pain management remains the most significant obstacle to pain treatment alongside an inadequate emphasis on pain education in undergraduate medical curricula, negatively impacting on subsequent care of patients. This study aimed to determine the effect of a 12-week structured e-Learning course on the knowledge of pain management among Nigerian undergraduate medical students. METHODS: Prospective, multisite, pre-post study conducted across five medical colleges in Nigeria. Structured modules covering aspects of pain management were delivered on an e-Learning platform. Pre- and post-test self-assessments were carried out in the 12-week duration of the study. User experience questionnaires and qualitative interviews were conducted via instant messaging to evaluate user experiences of the platform. User experience data was analysed using the UEQ Data Analysis Tool and Framework Analysis. RESULTS: A total of 216 of 659 eligible students completed all sections of the e-Learning course. Participant mean age was 23.52 years, with a slight female predominance (55.3%). Across all participants, an increase in median pre- and post-test scores occurred, from 40 to 60 (Z = 11.3, p<0.001, effect size = 1.3), suggestive of increased knowledge acquisition relating to pain management. Participants suggested e-Learning is a valuable approach to delivering pain education alongside identifying factors to address in future iterations. CONCLUSION: e-Learning approaches to pain management education can enhance traditional learning methods and may increase students' knowledge. Future iterations of e-Learning approaches will need to consider facilitating the download of data and content for the platform to increase user uptake and engagement. The platform was piloted as an optional adjunct to existing curricula. Future efforts to advocate and support integration of e-Learning for pain education should be two-fold; both to include pain education in the curricula of medical colleges across Nigeria and the use of e-Learning approaches to enhance teaching where feasible.

Utilization of surgical antibiotic prophylaxis for obstetrics and gynaecology surgeries in Northern Nigeria.

Background Audit of antibiotic prophylaxis is an important strategy used to identify areas where stewardship interventions are required. Objectives To evaluate compliance with surgical antibiotic prophylaxis in obstetrics and gynaecology surgeries and determine the Defined Daily Dose (DDD) of antibiotic. Settings Three public tertiary hospitals located in Northern Nigeria. Methods This prospective study included women who had obstetrics and gynaecology surgeries with no infection at the time of incision. Appropriateness of antibiotic prophylaxis was determined by a clinical pharmacist. DDD of antibiotics was determined using ATC/DDD index 2017 from the World Health Organization Collaborating Centre for Drugs Statistics Methodology. Main outcome measure Compliance with antibiotic prophylaxis and DDD of antibiotic per procedure. Results A total of 248 procedures were included (mean age: 31.7 ± 7.9 years). Nitroimidazole in combination with either beta-lactam/beta-lactamase inhibitor or third generation cephalosporin were the most prescribed antibiotics. Redundant anaerobic antibiotic combination was detected in 71.4% of the procedures. Timing of antibiotic prophylaxis was optimal in 16.5% while duration of prophylaxis was prolonged in all the procedures (mean duration was 8.7 ± 1.0 days). The DDD of antibiotics prophylaxis was 16.75 DDD/procedure. Antibiotic utilisation was higher in caesarean section and myomectomy (17.9 DDD/procedure) than hysterectomy (14.5 DDD/procedure); P < 0.001. Redundant metronidazole represents one-third of total DDD and 87% of the DDD for metronidazole. Conclusion Excessive and inappropriate use of antibiotic prophylaxis was observed in women who had obstetrics and gynaecology surgeries. These observations underline the need for antimicrobial stewardship interventions to improve antibiotic use.

Blood transfusion services for patients with sickle cell disease in Nigeria.

BACKGROUND: Safe, timely red blood cell transfusion saves lives and chronic transfusion therapy (CTT) prevents or limits morbidities such as stroke, therefore improving quality of life of patients with sickle cell disease (SCD). METHODS: This questionnaire-based study assessed the ability of sickle cell centers in Nigeria to provide safe blood to patients with SCD between March and August 2014. RESULTS: Out of the 73 hospitals contacted, responses were obtained from 31. Twenty four (78%) hospitals were unable to transfuse patients regularly due to blood scarcity. Packed red blood cells were available in 14 (45%), while only one provided leukocyte-depletion. Most centers assessed donor risk and screened for HIV in 30 (97%), hepatitis B in 31(100%) and hepatitis C in 27 (87%) hospitals. Extended phenotyping and alloantibody screening were not available in any center. A quarter of the hospitals could monitor iron overload, but only using serum ferritin. Access to iron chelators was limited and expensive. Seventeen (55%) tertiary hospitals offered CTT by top-up or manual exchange transfusion; previous stroke was the most common indication. CONCLUSION: Current efforts of Nigerian public hospitals to provide safe blood and CTT fall short of best practice. Provision of apheresis machines, improvement of voluntary non-remunerated donor drive, screening for red cell antigens and antibodies, and availability of iron chelators would significantly improve SCD care in Nigeria.

Pseudoachalasia: A review.

Pseudoachalasia presents typically like achalasia. It account for only 2.4-4% of patients presenting with achalasia-like symptoms. Clinical, radiologic and endoscopic findings resemble those of achalasia but treatment and prognosis are different in these conditions. The aim of this review is to give an overview of the condition and highlight challenges in diagnosis and distinguishing features between the two conditions. A review of the publications obtained from Medline search, medical libraries, and Google on 'pseudoachalasia' and 'secondary achalasia' was done. A total of 50 articles were retrieved and used for this review. There has been tremendous efforts towards establishing the diagnosis of pseudoachalasia both clinically and with the use of modern investigative modalities but to date its still difficult to distinguish it from achalasia. Endoscopy, endoscopic ultrasonography and computerized tomography scan have shown promising results.

A Prospective Study of Spectrum, Risk Factors and Immediate Outcome of Congenital Anomalies in Bida, North Central Nigeria.

BACKGROUND: Congenital disorders are structural, metabolic, behavioral and functional disorders that are present at birth. Their manifestations are protean ranging from mild anomalies to life-threatening conditions. AIM: The objectives of this study were to describe the congenital anomalies in children seen at Federal Medical Center, Bida over a 12 month period, determine possible factors associated with these anomalies; and their short term outcome. SUBJECTS AND METHODS: Children with clinically recognized congenital malformations were recruited consecutively over a 12 month period and socio-demographic, etiologic and other relevant clinical data were obtained. A detailed examination was also performed and abnormalities documented. The data was analyzed using Epi-info version 6 (Atlanta, USA). The Chi-square was used to identify significant differences for categorical variables. Mid-P and Fisher's exact tests were utilized as appropriate. A P < 0.05 was considered to be significant. RESULTS: A total of 46 children with congenital anomalies were seen during the study period, all which were recruited into the study. The hospital based prevalence amongst neonates was 111/1000 neonates. The most common system affected was the digestive system(50.0%) followed by the central nervous system and head and neck anomalies. There was no significant difference in distribution of anomalies amongst the various ethnic groups. About 22% of families were consanguineous, all being first cousins and 8.7% of mothers were greater than 35 years of age. The case fatality rate for congenital malformations was 2.2%, while 60.9% were referred to other hospitals for further care. CONCLUSION: The study has demonstrated a wide variety of congenital anomalies in Bida, North-Central Nigeria with the digestive system anomalies being the most frequent. The findings of this study strengthen the need for empowerment of the institution in appropriate management of these disorders.

Excision of a giant anterior chest wall neurofibroma and chest wall reconstruction with methlymethacrylate and vertical rectus abdominis musculocutaneous flap: case report.

INTRODUCTION: Plexiformneurofibromas (PNFs) are benign nerve tumours resulting from aberrant growth of cells of nerve sheath. PNFs are generally painless, slow growing neoplasms. Although most neoplasms are asymptomatic, they can be particularly debilitating due to their potential to grow to very large sizes. They have potential for transformation into highly malignant peripheral nerve sheath tumours which occur in approximately 5% of patients. They can affect most parts of the body. When they occur in the chest wall, they are amenable to excision. Following excision, a surgeon is faced with a large skeletal and soft tissue defects which pose functional and cosmetic challenges. CASE PRESENTATION: We present a 24-year-old farmer that presented with a giant anterior chest wall plexiformneurofibroma that was noticed since childhood. He had excision of the mass and skeletal reconstruction with methylmethacrylate sandwiched in prolene mesh and softtissue coverage with vertical rectus abdominismusculocutaneous flap. CONCLUSION: We conclude that the use of methylmethacrylate and myocutaneous flaps give both good functional and cosmetic outcome following excision of large chest wall tumours.

Pattern of Blood Transfusion Request and Utilization at a Nigerian University Teaching Hospital

Introduction: Provision of adequate safe blood is challenging in developing countries due to paucity of voluntary blood donors; poor facilities for storage and blood component preparation as well as inappropriate blood ordering and utilization. Appraisal of pattern of blood transfusion requests and utilization helps highlight shortcomings that could be addressed toward judicious use of blood. Aims: To determine the pattern of blood transfusion requests and utilization at a Nigerian Teaching Hospital. Materials and Methods: Blood request forms and cross-match worksheets at the blood bank of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto were analyzed over a 3-month period. Number of blood units requested; cross-matched; or transfused and the cross-match to transfusion ratio (CTR) for clinical units were computed. Results: Of the 1703 units of blood requested for 986 patients; 94.42 (1608) were cross-matched but only 34.51 (555) were transfused giving a CTR of 2.90 for the hospital. The CTR for the various clinical units were: O and G - 3.40; Surgery - 3.11; Trauma center - 2.74; Emergency - 2.61; Medicine - 2.02; and Pediatrics - 1.97. Conclusions: The overall CTR of the hospital is high indicating suboptimal transfusion practice. Introducing transfusion guidelines and type and screen with abbreviated cross-match method can help toward apt requisition and utilization of blood thereby reducing wastages

Effect of Plasma Storage on Prothrombin Time and Activated Partial Thromboplastin Time at a Nigerian Public Laboratory

Background: Prothrombin time (PT) and activated partial thromboplastin time (APTT) are the tests used in the investigation and monitoring of hemostatic disorders. Plasma is used to perform these tests immediately or stored for later use. The time and storage temperature have been shown to affect the results of these tests. Thus; all coagulation laboratories need guidelines for plasma storage to ensure reliable results. Objective: To determine the effect of varying storage times and temperatures on plasma PT and APTT. Materials and Methods: PT and APTT were run on plasma from 40 healthy adults using a semi-automated coagulometer. PT and APTT were measured at 0; 4; 6; and 24 h on samples stored at room temperature; refrigerated samples; and frozen samples. The values at 0 h were compared with the values at 4; 6; and 24 h. Results: PT and APTT values were within the reference ranges at 0 h. For refrigerated plasma; PT values at 4 h were within normal; but at 6 and 24 h; they were significantly deranged (P 0.05). PT was significantly different at 4; 6; and 24 h for both room temperature and frozen plasma (P 0.05). The APTT showed significant differences between 0 h value and values at 4; 6; and 24 h for all the varying temperature conditions. Conclusion: For reliable PT and APTT results; samples should be processed and run immediately after collection. However; plasma for PT can be stored at 2o-4oC for only 4 h

Tuberculosis in humans and cattle in jigawa state, Nigeria: risk factors analysis.

A cross-sectional study was conducted from September 2008 to March 2009 to identify risk factors for BTB in cattle and humans in Jigawa State, Nigeria. A total of 855 cattle belonging to 17 households were subjected to comparative intradermal tuberculin test (CITT) while interviewer-administered questionnaire was used to obtains information on the risk factors. Twenty-two (22) respondent (5%) amongst the families sampled had TB or clinical signs suggestive of TB, while 9 (2%) had reactor cattle in their herds; However, no statistically significant association (P ≥ 0.05) was observed between reactor cattle and human TB cases in the households. The habit of milk and meat consumption was found to be affected by occupation and location of the household residence. None of these risk factors (food consumption, living with livestock in the same house, and presence of BTB-positive cattle) were found to be statistically significant.

Bilateral opening in the nasal bones of goats in Nigeria

The present study was performed to observe the morphological details of the skulls of the major goat breeds in Nigeria involving 28 Red Sokoto, 24 Sahel and 12 West African Dwarf goats. The study revealed the presence of a bilateral opening in the nasal bones of the skulls. This unique occurrence appeared in about 70 of the Red Sokoto, less than 10 of the West African Dwarf and did not occur in the Sahel goat skulls. It was suggested that the structure which displayed a high level of breed specificity may be contributing to the weakness of the nasal area of the face. This finding to the best of our knowledge is rarely described in the literature and will be important in breed identification of goats and can contribute to the migratory history of the species.

Burkitt's lymphoma presenting as obstructive jaundice.

A 12-year-old boy presented with a 5-month history of yellowness of the eyes, progressive painless abdominal swelling and weight loss. Physical examination revealed a grossly wasted child with marked jaundice and non-tender hepatomegaly. Liver function tests and abdominal ultrasound suggested obstructive liver disease. Tissue biopsy at laparotomy showed histological findings consistent with Burkitt's lymphoma. He was commenced on cytotoxic chemotherapy and, after two courses, the jaundice disappeared and he remained well. Although ante-mortem presentation of Burkitt's lymphoma as hepatic disease is rare, this condition should be included in the differential diagnosis of a child with obstructive jaundice.

Chemical composition of seeds and oil of Xylopia aethiopica grown in Nigeria.

The chemical composition and mineral constituents of Xylopia aethiopica, which is valued as a spice in Nigeria, were determined along with the physicochemical characteristics of the seed oil. The seeds had the following chemical compositions moisture (8.43 g/100 g), ash (5.89 g/100 g), crude lipid (9.58 g/100 g), crude protein (12.45 g/100 g) crude fiber (8.66 g/100 g) and carbohydrate (63.65 g/100 g). Calcium and potassium were the major minerals in the seed. The extracted lipid was examined for fatty acid composition. Linoleic (45.1 g/100 g) and oleic (26.5 g/100 g) acids were the predominant unsaturated fatty acids, while palmitic acid (18.0 g/100 g) was the major saturated acid. The iodine value of 97 g/100 g indicates that the seed oil is a non-drying type.

cDNA cloning and characterisation of novel ripening-related mRNAs with altered patterns of accumulation in the ripening inhibitor (rin) tomato ripening mutant.

A cDNA library produced from mRNA isolated from the pericarp of wild-type tomato fruit (Lycopersicon esculentum Mill. cv Ailsa Craig) at the first visible sign of fruit ripening was differentially screened to identify clones whose homologous mRNAs were present at reduced levels in fruit of the tomato ripening mutant, ripening inhibitor,rin. Five clones were isolated (pERT 1, 10, 13, 14, 15). Accumulation of mRNA homologous to each of these clones increased during the ripening of wild-type fruit and showed reduced accumulation in ripening rin fruit. The levels of three of them (homologous to ERT 1, 13 and 14) were increased by ethylene treatment of the mutant fruit. A further clone, ERT 16 was identified for a mRNA present at a high level in both normal and mutant fruit at early stages of ripening. Database searches revealed no significant homology to the DNA sequence of ERT 14 and 15; however, DNA and derived amino acid sequence of ERT 1 both contain regions of homology with several reported UDP-glucosyl and glucuronosyl transferases (UDPGT) and with a conserved UDPGT motif. A derived amino acid sequence from the ERT 10 cDNA contains a perfect match to a consensus sequence present in a number of dehydrogenases. The ERT 13 DNA sequence has homology with an mRNA present during potato tuberisation. The presence of these mRNAs in tomato fruit is unreported and their role in ripening is unknown. The ERT 16 DNA sequence has homology with a ripening/stress-related cDNA isolated from tomato fruit pericarp.