Five traditional Nigerian Polyherbal remedies protect against high fructose fed, Streptozotocin-induced type 2 diabetes in male Wistar rats.

BACKGROUND: This present study sought to assess the modulatory effects of five Nigerian traditional polyherbal in high fructose-fed, streptozotocin-induced (HF-STZ) Type 2 diabetes (T2D) in rats. T2D was achieved via fructose feeding (20%W/V) ad libitum for 2 weeks and streptozotocin (STZ, 40 mg/kg) (15th Day) intraperitoneally. METHODS: Seventy-two hours after STZ injection, fourty-eight diabetic rats were divided into eight of 6 rats/group: Diabetic normal untreated, glibenclamide (GBLI, 0.07 mL/kg) or yoyo (YB, 0.43), ruzu (RB, 0.08), fajik (FJB, 0.20), oroki (OB, 0.16), and fidson (FB, 0.43)/ mL/kg bitters respectively. Controls normal and diabetic untreated groups received intragastric carboxylmethylcellulose (CMC, 1 mL/kg) for eleven days. RESULTS: T2D was characterized in rats by an increased (p < 0.001-0.05) blood glucose levels (BGL), total cholesterol, triglycerides, low-density lipoprotein and alanine aminotransferase compared with control CMC group. Similarly, hepatic and pancreatic malondialdehyde (MDA) were increased by 180 and 97% respectively. Polyherbal treatments demonstrated efficacies on BGL as follow: YB (55.6%, 160.7 mg/dL); RB (59.7%, 145.2 mg/dL); FJB (59.8%, 243.4 mg/dL); OB (60.8%, 194.5 mg/dL) and FB (61.3%, 203.3 mg/dL) respectively by day 11 (versus GBLI, 65.1%) compared with control untreated diabetic rats. Also, elevated TC, LDL cholesterol, ALT were lowered (p < 0.05) by YB, FJB, and FB respectively in rats. YB, FJB, and OB lowered MDA levels in treated rats. Further, YB, RB, FJB and FB restored changes in liver, and pancreas histopathology. Predominant non-polar bioactive include oleic, hexadecanoic, octadecanoic among others following gas chromatography-mass spectrophotometry analyses. CONCLUSION: Overall, these present results demonstrate anti-hyperglycemic potentials, although with cautions, of some polyherbal in T2D rats, which may, in part, be antioxidants mediated.

Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study.

OBJECTIVE: To explore what "quality of care" means to childbearing women in Nigeria and Uganda, as a means of ensuring that women's voices and opinions are prioritized when developing interventions to improve quality in maternity care provision. METHODS: Qualitative methods, with a purposive sample of women in Nigeria and Uganda. Participants were asked to define quality of care and to provide examples of when it was and was not provided. Thematic analysis was used to synthesize findings based on an a priori framework (the WHO quality of care framework). RESULTS: 132 in-depth interviews and 21 focus group discussions are included. Participants spontaneously discussed each of the WHO framework domains of quality of care. Data were richest across the domains of effective communication, respect and dignity, emotional support, competent and motivated human resources, and essential physical resources. Women believed that good quality of care ensured optimal psychological and physiological outcomes for the woman and her baby. Positive interpersonal relationships between women and health providers were important. These included supportive care, building rapport, and using positive and clear language. CONCLUSION: To provide good quality of care, maternity services should consider and act on the expectations and experiences of women and their families.

The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study.

OBJECTIVE: To improve women's childbirth experiences in health facilities, their psychosocial and communication needs have to be met. However, what constitutes these specific needs is poorly understood, particularly in Sub-Saharan Africa. This paper explores women's needs for communication and emotional support during facility-based childbirth. METHODS: Qualitative research was conducted in a large referral maternity hospital and its catchment communities in Akure, Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted among women of reproductive age, midwives, doctors, and facility administrators. Thematic analysis was used to synthesize findings, and then interpreted within the context of this study and existing quality of care framework. RESULTS: Forty-two IDIs and 10 FGDs are included in this analysis. Participants reported such needs as communication in simple words in local language by healthcare staff, having their husbands as birth companions, spiritual support, and prayers from family members and healthcare providers. CONCLUSION: To increase, improve, and sustain facility-based childbirth in Nigeria, health systems should appreciate the uniqueness and importance of each woman's needs during childbirth. Practical and sustainable actions should be taken to meet these needs, within the confines of the acceptable sociocultural norms.

Healthcare providers' perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities.

OBJECTIVE: To explore current practices, challenges, and opportunities in relation to monitoring labor progression, from the perspectives of healthcare professionals in low-resource settings. METHODS: Thematic analysis of qualitative data (in-depth interviews [IDIs] and focus group discussions [FDGs]) obtained from a purposive sample of healthcare providers and managers in selected health facilities in Nigeria and Uganda. RESULTS: A total of 70 IDIs and 16 FGDs with doctors, midwives, and administrators are included in this analysis. Labor monitoring encompasses a broad scope of care jointly provided by doctors and midwives. A range of contextual limitations was identified as barriers to monitoring labor progression, including staff shortages, lack of team cooperation, delays in responding to abnormal labor observations, suboptimal provider-patient dynamics, and limitations in partograph use. Perceived opportunities to improve current practices included streamlining clinical team cooperation, facilitating provider-client communication, encouraging women's uptake of offered care, bridging the gaps in the continuum of monitoring tasks between cadres, and improving skills in assessment of labor progress, and accuracy in its documentation. CONCLUSION: Healthcare providers face many challenges to effective monitoring of labor progress in low-resource settings. This analysis presents potential opportunities to improve labor monitoring practices and tools in these contexts.

Negotiating quality standards for effective delivery of labor and childbirth care in Nigeria and Uganda.

OBJECTIVE: "Negotiated standards" describe a level of quality of care that is acceptable and achievable within a specific health system, based on consensus between key stakeholders. This paper presents the development of negotiated standards for effective labor and childbirth care in selected hospitals and communities in Nigeria and Uganda. METHODS: A four-step development process involving different methodologies. The process included: (1) review and synthesis of internationally recognized intrapartum clinical principles and practices; (2) primary qualitative research to assess values and preferences of women and healthcare providers, and practices that align with these preferences; (3) draft contextualization of effective and ineffective behaviors to reflect values and preferences; and (4) WHO-mediated negotiations between relevant stakeholders, including community members, providers, and administrators. RESULTS: The primary outcomes of this process were a comprehensive set of effective behaviors and clinical practices covering the main domains of quality of care, which are practical and easy to communicate, implement, and audit across all levels of healthcare delivery. CONCLUSION: The process demonstrates that health facilities and providers can be motivated to adopt standards of care that uphold the values and preferences of both service users and providers, while adhering to international best practices.

Safety of transtympanic application of 4 % manuka honey in a chinchilla animal model.

The antimicrobial and anti-biofilm properties of manuka honey (MH) are currently being explored in the treatment of chronic recalcitrant rhinosinusitis. Due to similarities between chronic rhinosinusitis and chronic otitis, manuka honey may find applications in the management of challenging cases of chronic otitis media implicating biofilms. The goal of this study was to investigate the safety of topical application of 4 % MH in the middle ear. Eleven adult female chinchillas had one of their ears randomly assigned to receive transtympanic 4 % MH, while the contralateral ear served as control. Auditory brainstem-evoked response (ABR) was performed before and after MH application. The facial nerve function and vestibular system were assessed clinically. The animals were euthanized one month following the last application, and the cochleae samples were processed for light and scanning electron microscopy. There was no statistically significant differences between ABR thresholds in both control and experimental ears before and after the application of MH. No morphological differences were seen in both groups of cochleae. The outer hair cell counts for both groups were comparable. Our results suggest that 4 % MH appears not toxic to the cells of the cochlea after 4 weeks of application. The long-term effects of prolonged contact on the structure and function of the cochlea however need further investigations.

Hearing outcome of early postnatal exposure to hypoxia in Sprague-Dawley rats.

Objective: To determine the effect of experimentally induced hypoxia, in the first 10 days of life, on physiological hearing in a Sprague-Dawley rat model. Methods: A prospective, controlled animal study was carried out using 22 male rat pups. The rats in the hypoxic group (n = 12) were reared in hypoxia for the first 10 days of life, and subsequently reared in normoxia, while those in the control group (n = 10) were reared in normoxia for the duration of the experiment. Hearing was assessed using auditory brainstem response testing at approximately 72 days of age. Results: The hypoxia group had higher auditory brainstem response thresholds for all frequencies tested (more pronounced at 16 kHz), compared with controls. Wave I-V inter-peak latencies were more prolonged in the hypoxic rats, while both groups had similar wave I latencies. Conclusion: Chronic postnatal hypoxia induced permanent hearing loss in this Sprague-Dawley rat model. Prolonged wave I-V inter-peak latencies suggested functional abnormality in the central auditory pathway.

Bilateral tubal gestation associated with schistosomiasis in an african woman.

Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3(+0) (3 alive) woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days' duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide). Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.

Ototoxicity of baby oil in a chinchilla animal model.

OBJECTIVE: Baby oil is commonly used to soften ear wax in order to aid its removal. The aim of this study was to determine the potential ototoxicity of baby oil. METHOD: A prospective controlled animal study was conducted using ten chinchillas with normal hearing function. Each had bilateral myringotomies. One ear was randomly assigned to receive 1 ml of baby oil while the other ear received an equal volume of 0.45% NaCl. Distortion product otoacoustic emissions (DPOAEs) and Auditory Brainstem Response (ABR) measurements were recorded at baseline (post myringotomy and pre application of product) and on days 5 and 15 after application. Two months after application of baby oil, the cochleae were processed for light microscopy and qualitative comparisons were made between the cochleae of both control and experimental ears. RESULTS: There was no statistically significant difference in DPOAE between experimental and control ears at 5 and 15 days after treatment. ABR results did not reveal ototoxicity at days 5 and 15 post treatment. None of the animals developed facial paralysis or any signs of vestibular toxicity. There were no overt mucosal changes in the middle ear of the ears exposed to baby oil compared to the control ears. Light microscopy showed comparable features in the organ of Corti, stria vascularis, spiral ligament and the spiral ganglion cells of both groups of cochleae. CONCLUSION: Baby oil did not produce ototoxic effects when applied ototopically in chinchillas with non-intact tympanic membrane.

Sexual dimorphism of head morphology in three-spined stickleback Gasterosteus aculeatus.

This study examined sexual dimorphism of head morphology in the ecologically diverse three-spined stickleback Gasterosteus aculeatus. Male G. aculeatus had longer heads than female G. aculeatus in all 10 anadromous, stream and lake populations examined, and head length growth rates were significantly higher in males in half of the populations sampled, indicating that differences in head size increased with body size in many populations. Despite consistently larger heads in males, there was significant variation in size-adjusted head length among populations, suggesting that the relationship between head length and body length was flexible. Inter-population differences in head length were correlated between sexes, thus population-level factors influenced head length in both sexes despite the sexual dimorphism present. Head shape variation between lake and anadromous populations was greater than that between sexes. The common divergence in head shape between sexes across populations was about twice as important as the sexual dimorphism unique to each population. Finally, much of the sexual dimorphism in head length was due to divergence in the anterior region of the head, where the primary trophic structures were found. It is unclear whether the sexual dimorphism was due to natural selection for niche divergence between sexes or sexual selection. This study improves knowledge of the magnitude, growth rate divergence, inter-population variation and location of sexual dimorphism in G. aculeatus head morphology.

Review of skull base surgery in a Nigerian teaching hospital.

BACKGROUND AND OBJECTIVES: There is dearth of information on skull base surgery in Nigerians. This study was conducted to determine types of skull base lesions describe surgical approaches to the lesions and determine outcome of surgical management of the lesions over the study period. METHODS: We retrospectively reviewed the case notes of the patients who underwent skull base neurosurgical procedures between January 2001 and June 2007 in our centre. We obtained information on demography, clinical presentation, diagnosis, cranial computerised tomography findings, type of surgery, intraoperative findings and outcome of surgical management at the time of discharge from the hospital. RESULTS: Brain tumours were diagnosed in 28 patients, head injuries in 9 patients and one patient each had anterior encephalocele and frontal sinus mucocele. Eighteen patients had frontal craniotomy, three patients had temporal craniotomy and two patients had lateral rhinotomy in addition to bifrontal craniotomy. Two patients had frontoorbitotomy while retrosigmoid craniectomy was performed in one patient. Thirty three patients showed significant postoperative improvement at discharge. CONCLUSION: Brain tumour was the most common indication for skull base surgery in our centre. These tumours were mainly located in the anterior cranial fossa. Frontal craniotomy was the most common surgical approach. Non-availability of modern neurosurgical facilities confined us to the use of mainly traditional approaches. The availability of these facilities will assist in improving our management outcome in the future.

Back school: the development of a Nigerian urban model.

BACKGROUND: Back Schools are health education and behaviour modifying programmes for care of the back and prevention of back injuries, usually available as video documentary. They are often developed with consideration for the environment and the practices of the people they serve. Although back schools are available in many parts of the world, none has been developed for the Nigerian environment. OBJECTIVE: To develop a back school model for the Nigerian urban setting. METHODS: The Nigerian Back School (NBS) was developed from two existing video documentaries and series of focus group discussions. The focus group discussions suggested how to adapt these documentaries to the Nigerian environment and cultural practices. A hand book containing illustrations on wrong and correct postures was also developed. RESULTS: The NBS comprises 30-minute video documentary and a 24-page handbook. The first part of the video documentary provides information on the epidemiology and causes of back pain, structures and functions of the back while the second and third parts consist of demonstrations of wrong and correct resting and working postures assumed during everyday life activities and simple exercises for the prevention or alleviation of back pain or its recurrence respectively. The NBS handbook consists of illustrations on wrong and correct postures assumed at rest and during activity of daily living CONCLUSION: A back school (video documentary and handbook) with considerations for the Nigerian urban environment and the peoples' practices was made available.

A retrospective analysis of aetiology and management of epistaxis in a south-western Nigerian teaching hospital.

BACKGROUND: Epistaxis is a common otolaryngological emergency and is often due to lesions within or around the nose and systemic conditions. Controlling epistaxis presents a challenge in the underdeveloped, resource-poor centres where there are limited facilities. OBJECTIVE: To describe the aetiopatogenesis of epistaxis in our hospitals. METHODS: This was a retrospective review of the cases of epistaxis managed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, over a three-year period: January 2003 - through December, 2005. Information on sociodemographic characteristics, clinical presentation and management of epistaxis was obtained from the hospital records both in the accident and emergency units and the ENT outpatient clinic. RESULTS: A total of 106 cases were managed during the period. The peak age incidence was in the 21-40-year group. There was a significant male preponderance, ratio 3.4:1. Trauma contributed to 75 (70.9%) of the cases managed. Maxillofacial injuries were the most common injury encountered (50.7%). This was mainly secondary to the road traffic accident (RTA). Malignant neoplasms were the second most common aetiological factor seen in this study while idiopathic causes were the third most common. There were two cases with systemic problems associated with renal failure. Nasal packing was adequate to control the epistaxis in most cases. Nasal packing was done with gloved finger cots and vasellinated gauze. Two patients (1.9%) had external carotid artery ligation. Eleven patients (10.4%) received blood transfusion. CONCLUSION: Epistaxis is a common presentation of head and neck trauma. Non-surgical control of epistaxis (nasal packing) is adequate in many cases. Reducing the incidence of trauma from RTA will reduce the incidence of emergency epistaxis in our centers.

Back School: the Development of a Nigerian Urban Model

Background: Back Schools are health education and behaviour modifying programmes for care of the back and prevention of back documentary. They are often developed with consideration for the environment and the practices of the people they serve. Although back schools are available in many parts of the world; none has been developed for the Nigerian environment. Objective: To develop a back school model for the Nigerian urban setting. Methods: The Nigerian Back School (NBS) was developed from two existing video documentaries and series of focus group discussions. The focus group discussions suggested how to adapt these documentaries to the Nigerian environment and cultural practices. A hand book containing illustrations on wrong and correct postures was also developed. Results: The NBS comprises 30-minute video documentary and a 24-page handbook. The first part of the video documentary provides information on the epidemiology and causes of back pain; structures and functions of the back while the second and third parts consist of demonstrations of wrong and correct resting and working postures assumed during everyday life activities and simple exercises for the prevention or alleviation of back pain or its recurrence respectively. The NBS handbook consists of illustrations on wrong and correct postures assumed at rest and during activity of daily living Conclusion: A back school (video documentary and handbook) with considerations for the Nigerian urban environment and the peoples' practices was made available

Challenges in management of chronic suppurative otitis media in a developing country.

BACKGROUND: In developing countries, the rate of complications from chronic suppurative otitis media is still high, due to factors associated with poverty. This study aimed to determine the prevalence of chronic suppurative otitis media and associated complications. PATIENTS AND METHODS: We prospectively studied all patients presenting with chronic suppurative otitis media to the ear, nose and throat unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, over a two-year period. RESULTS: One hundred and sixty new cases of chronic suppurative otitis media were seen. These constituted 11.1 per cent of all new cases and 21.5 per cent of all otological cases seen. About half (51.7 per cent) of these patients were younger than 15 years. Most patients were from rural areas and had been previously managed by unlicensed, untrained practitioners. Complications were mostly seen in children. Intracranial complications were seen in 10 (6.3 per cent) cases; this was associated with a high mortality rate. CONCLUSION: This study found that, in Nigeria, a developing country, 'safe' chronic suppurative otitis media was not without serious problems. Provision of adequate health facilities may reduce such problems.

Oesophageal denture impaction producing Horner's syndrome: a case report.

BACKGROUND: Dentures in the oesophagus have been associated with various complications; however, Horner's syndrome following denture impaction has not been reported in our locality. CASE REPORT: Horner's syndrome developed in a 26-year-old woman following accidental swallowing of an upper denture which then became impacted in the oesophagus. The denture was retrieved via cervical oesophagotomy. The syndrome abated completely by the seventh day post-surgery. The clinical features of Horner's syndrome are discussed. CONCLUSION: Compression of the stellate ganglion, with resultant Horner's syndrome, can be associated with denture impaction in the cervical oesophagus.

Extensive multiple test centre evaluation of the VecTest malaria antigen panel assay.

To determine which species and populations of Anopheles transmit malaria in any given situation, immunological assays for malaria sporozoite antigen can replace traditional microscopical examination of freshly dissected Anopheles. We developed a wicking assay for use with mosquitoes that identifies the presence or absence of specific peptide epitopes of circumsporozoite (CS) protein of Plasmodium falciparum and two strains of Plasmodium vivax (variants 210 and 247). The resulting assay (VecTest Malaria) is a rapid, one-step procedure using a 'dipstick' test strip capable of detecting and distinguishing between P. falciparum and P. vivax infections in mosquitoes. The objective of the present study was to test the efficacy, sensitivity, stability and field-user acceptability of this wicking dipstick assay. In collaboration with 16 test centres world-wide, we evaluated more than 40 000 units of this assay, comparing it to the standard CS ELISA. The 'VecTest Malaria' was found to show 92% sensitivity and 98.1% specificity, with 97.8% accuracy overall. In accelerated storage tests, the dipsticks remained stable for > 15 weeks in dry conditions up to 45 degrees C and in humid conditions up to 37 degrees C. Evidently, this quick and easy dipstick test performs at an acceptable level of reliability and offers practical advantages for field workers needing to make rapid surveys of malaria vectors.

Unexpected anthropophagic behaviour in Anopheles quadriannulatus.

The strongly anthropophilic behaviour of Anopheles gambiae Giles sensu stricto (Diptera: Culicidae), the most important malaria vector in Africa, has been demonstrated by field and laboratory studies. Other members of the An. gambiae complex express varied degrees of anthropophily. Anopheles quadriannulatus (Theobald) species A and B are more zoophilic members of the complex and hence are considered to be of no medical importance. Olfactometer experiments with An. quadriannulatus species A have demonstrated attraction to both human and cow odour. To extend these olfactometer observations a choice experiment was conducted in an outdoor cage with a human and a calf as baits, using laboratory-reared mosquitoes. Anopheles gambiae s.s. (from Liberia) and two strains of An. quadriannulatus species A (SKUQUA from South Africa, SANGQUA from Zimbabwe), marked with different coloured fluorescent powders for identification purposes, were released simultaneously and given an equal opportunity to feed on either host. The experiment was repeated six times. Bloodmeals were identified using the precipitin technique. Anopheles gambiae s.s. showed highly anthropophagic behaviour, taking 88% of bloodmeals from the human host. In contrast, both strains of An. quadriannulatus fed with equal frequency on the human or the calf; the response to either host was not significantly different. These results confirm the olfactometer findings and demonstrate anthropophagic behaviour not previously recorded in this species. This finding has implications for prospective manipulation of host preference for genetic control purposes.