Predictors of Obesity Among Nigerian Immigrants in the United States

Obesity is a highly prevalent cardiovascular disease risk factor globally and in African-descent populations. A cross-sectional study of obesity among a Nigerian immigrant sample population in the United States was conducted. Data was obtained through a web-based survey. Spearman’s correlation and logistic regression were used to determine sociodemographic and behavioral determinants of obesity. The results showed no significant relationship between obesity and education, socioeconomic status, length of stay, and level of physical activity. However, we identified a significant association between weekly consumption of alcohol and all obesity (OR 1.78, 95 % CI 1.091, 2.919), and moderate/morbid obesity (OR 2.46, 95 % CI 1.213, 4.999), and between gender and moderate/morbid obesity—men were less likely (OR .030, 95 % CI .001, .733) to be obese. These findings provide strong evidence to inform targeted screening for excessive alcohol consumption along with other primary prevention strategies that may reduce the prevalence of obesity among the Nigerian immigrant population.     

Incorporating correlation in interindividual variability for the optimal design of multiresponse pharmacokinetic experiments

This paper presents a method for optimal design of multiresponse population pharmacokinetic experiments taking into account correlations between interindividual variances. Expressions for the population Fisher information matrix have been defined for uniresponse and multiresponse pharmacokinetic experiments. A major assumption often made is that the variance-covariance matrix of the interindividual variance components has only diagonal elements so that whenever intersubject covariance elements are present, they are ignored during the design of the experiment. Recently expressions that accounted for these off diagonal elements were developed for uniresponse population pharmacokinetic experiments. The work presented here extends these expressions to multiresponse population pharmacokinetic experiments. These were applied to a population pharmacokinetic model, a population pharmacokinetic-pharmacodynamic model, and a parent-metabolite pharmacokinetic model example. The results obtained showed that optimal designs are different with diagonal omega matrix and full omega matrix and ignoring the off diagonal elements can lead to a design that produces more biased and less precise parameter estimates compared to a design that includes the off diagonal elements. The results also showed correlation between residual components of the responses has an effect on the optimal design.     

Principles of Electrical Stimulation and Dorsal Column Mapping as it Relates to Spinal Cord Stimulation: An Overview

The last 30 years have witnessed the growth of spinal cord stimulation as a treatment modality for an increasing number of chronic pain conditions. In spite of this growth, one of the greatest criticisms is the lack of concrete evidence for the mechanism of action. With the ever increasing enlightenment with regards to the neurophysiology of pain, and the development of more dynamic neuroimaging techniques, the opportunity to better define the mechanism of action of the spinal cord stimulator will continue to expand. In the interim, clinicians will benefit from the consolidation of the available knowledge that will enhance the effective use of the device. This review serves to provide an overview of the key principles of electrical stimulation and dorsal column mapping as it relates to spinal cord stimulation. We aim at enhancing the understanding regarding the basis for successful placement of leads and manipulation of electrical parameters.     

Case Based Surveillance for Measles in Lagos,South Western Nigeria,September 2011

Objective

The objective of this study was to describe the performance of the measles surveillance in Lagos, characterize the epidemiologic pattern of measles infection and determine the measles vaccine efficacy.

Introduction

Measles is a vaccine preventable disease that has been successfully eliminated in some parts of the world. It causes high morbidity and mortality with the potential of large outbreaks. About a third of reported measles cases involve one or more complications including diarrhea, pneumonia, otitis media, blindness, post infections encephalitis and subacute sclerosing panencephalitis. It is however, one of the leading causes of childhood morbidity and mortality in Nigeria despite availability of safe and effective vaccines

Methods

We obtained the measles surveillance data for all the 20 Local Governments Areas (LGAs) in Lagos and reviewed all the measles case based investigation forms between the period 1st January to 31st December 2010.The WHO Recommended Surveillance Standards for Measles was used. Data was analyzed using EPI INFO version 3.5.3.

Results

Of the 615 suspected measles cases, 63(10.2%) were laboratory confirmed (measles IGM+) and 3(0.5%) clinically confirmed. Cases investigated within 48 hours was 222 (36%) (target ≥ 80%), 510 (83%) had adequate blood sample collected (target ≥ 80%) and 595 (97%) of sample results were received from the lab within 7 days (target ≥ 80%). The surveillance system sensitivity was 6.5/100,000 (target >2/100,000) with a predictive value positive of 10.73%. The overall attack rate was 0.73/100,000 population with 1 mortality (case fatality rate 1.5%). The Under 1 year attack rate (8.33/100,000) was higher than the 1– 4 years attack rate (3.48/100,000) (p= 0.01). Those vaccinated with at least 1 dose of measles vaccine had a 3 times lower risk of measles infection than the unvaccinated. The proportion of unvaccinated cases was 36%. The measles vaccine efficacy was 60%.

Conclusions

The quality of surveillance need to be strengthened by improving the time lapse between notification and investigation of suspected cases. Measles is still a significant cause of morbidity particularly among the under 1 year age group.The proportion of unvaccinated cases is also high, suggesting a low vaccine coverage among susceptibles.Prompt investigation of cases, good vaccine coverage and high vaccine efficacy are all vital in eliminating measles from Nigeria.Morbidity and Mortality rates

The role of informed consent in risks recall in otorhinolaryngology surgeries: verbal (nonintervention) vs written (intervention) summaries of risks

Background

Informed consent is a phrase often used in the law to indicate that the consent a person gives meets certain minimum standards. It relies on patients' ability to understand risk information. Evidence suggests that people may extract the gist of any risk information to make medical decisions. Existing evidence also suggests that there is an inverse relationship between the perception of risk and the perception of benefit. Informed consent is the method by which fully informed, rational persons may be involved in choices about their health care.

Aim

The aims of this study were to study how much patients remember of the risks discussed with them about their otolaryngologic surgery and to evaluate whether a simple intervention, the addition of an information handout, improves their recall.

Methods

This was a prospective study carried out between January and December 2009 in the Department of Otorhinolaryngology, University of Ilorin teaching hospital. Fifty patients undergoing a variety of otorhinolaryngologic procedures, including mastoidectomy, tympanoplasty, nasal polypectomy, rhinotomy, maxillectomy, and laryngoscopy, were verbally consented by the operating surgeon with a standard checklist of potential surgical complications and adverse effects. Three surgeons participated in the study. Patients were stratified into 2 groups: a higher education group and a lower education group. Within each group, patients were randomized to either a control group, consisting of a verbal explanation only, or an intervention group, which added a written handout to the verbal explanation. A follow-up telephone interview was conducted at an average of 20.6 days (range, 14-53 days) to survey for recall of the complications discussed. The main outcome measure is risk recall. This was analyzed by education level and written sheet intervention. Other parameters examined were patient demographics and time elapsed from when the consent was obtained.

Results

Of the 50 patients involved in the study, 30 were men and 20 were women, with male/female ratio of 1.5:1.0. The average age was 43 years (range, 16-76 years). With respect to educational status, 26 patients had the equivalent of high school or less (group 1), and 24 had some degree of postsecondary training (group 2). Overall recall of potential complications was 56%. Those who received the handout recalled 67% of the complications overall, whereas those who did not receive the handout remembered 51% of the complications. The difference was significant Recall of the specific risks varied considerably. For those with potential risk of facial nerve paralysis, 88% of them recalled, which was the highest in the study. This was followed by hearing loss (85%) and nasal adhesion (23%). The least were anesthetic reactions (4%) and hoarseness (2%). Those who received the handout recalled 62% of the complications overall, whereas those who did not receive the handout remembered 51% the complications.

Conclusion

The addition of a handout significantly alters recall of potential complications of otorhinolaryngologic surgery with the recall of specific risk highest for facial nerve paralysis.     

Anti-inflammatory, analgesic and anti-lymphocytic activities of the aqueous extract of Crinum giganteum

The anti-inflammatory, anti-lymphocytic and analgesic properties of Crinum giganteum, a popular herb used for the management of asthma and other respiratory disorders was investigated in rats and mice. The extract dose-dependently produced significant (P<0.05) inhibition of formalin induced pain in rats. It also demonstrated significant (P<0.01) inhibition of abdominal constriction induced with 0.75% v/v acetic acid in mice. On the cotton pellet induced granulomatous tissue formation in rats, the extract significantly (P<0.05) decreased the weight. However, no significant inhibition was observed in the egg albumin-induced inflammation in rats. Oral administration of this extract in rats for 14 days significantly affected (P<0.05) the total leukocyte count and the overall percentage lymphocytes. The intraperitoneal and per oral LD(50) were 627+/-5.8mg/kg and 1486+/-18.9 mg/kg in mice and 520+/-10.2mg/kg and 1023+/-4.3 mg/kg in rats, respectively. Preliminary phytochemical analysis of the extract indicates the presence of tannins. These results therefore indicate that C. giganteum bulb contains biologically active principles, which have potentials for the treatment of inflammatory processes.