Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital

Background:

Parents are central in decisions and choices concerning circumcision of their male children and plastibell circumcision is a widely practiced technique. This study determined parental preferences for male neonatal and infant circumcisions and evaluate the early outcomes of plastibell circumcisions in a tertiary centre.

Patients and Methods:

This is a prospective study on consecutive male neonates and infants who were brought for circumcisions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South-East Nigeria and their respective parents between January 2012 and December 2012. Data on demography, parental choices and early outcome of plastibell circumcision were obtained and analysed.

Results:

A total of 337 requests for circumcisions were made for boys with age range of 2-140 days. Culture and religion were the most common reasons for circumcision requests in 200 (59.3%) and 122 (36.2%), respectively, other reasons were medical, cosmesis, to reduce promiscuity and just to follow the norm. Most parents, 249 (73.9%) preferred the procedure to be performed on the 8^th day and 88.7% would like the doctors to perform the procedure while 84.6% preferred the plastibell method. Among those who had circumcision, 114 complied with follow-up schedules and there were complications in 22 (19.3%) patients. Parents assessed the early outcome as excellent, very good, good and poor in 30.7%, 45.6%, 18.4% and 5.3% of the patients, respectively.

Conclusion:

Parents request for male circumcision in our environment is largely for cultural and religious reasons; and prefer the procedure to be performed by a physician. Plastibell method is well known and preferred and its outcome is acceptable by most parents.Key words: Complications, infants, neonates, Nigeria, plastibell circumcisions, preferences     

Incarceration and Current Tobacco Smoking Among Black and Caribbean Black Americans in the National Survey of American Life

Objectives. We examined the relationship between having a history of incarceration and being a current smoker using a national sample of noninstitutionalized Black adults living in the United States.Methods. With data from the National Survey of American Life collected between February 2001 and March 2003, we calculated individual propensity scores for having a history of incarceration. To examine the relationship between prior incarceration and current smoking status, we ran gender-specific propensity-matched fitted logistic regression models.Results. A history of incarceration was consistently and independently associated with a higher risk of current tobacco smoking in men and women. Formerly incarcerated Black men had 1.77 times the risk of being a current tobacco smoker than did their counterparts without a history of incarceration (95% confidence interval [CI] = 1.20, 2.61) in the propensity score-matched sample. The results were similar among Black women (prevalence ratio = 1.61; 95% CI = 1.00, 2.57).Conclusions. Mass incarceration likely contributes to the prevalence of smoking among US Blacks. Future research should explore whether the exclusion of institutionalized populations in national statistics obscures Black–White disparities in tobacco smoking.In the United States, local, state, and national measures first enacted in the 1970s and 1980s under the “war on drugs” and “tough on crime” policies radically changed the criminal justice system as well as the social, economic, and political landscapes.1 As a result, the US incarceration rate soared higher than that of Russia by 2001.2 The overall incarceration rate has increased by more than 400% since 1980, and the incarceration rate associated with felony drug offenses has increased by 1100%.3,4 Black Americans have borne the brunt of these criminal justice policy changes. One in 21 Black men and 1 in 279 Black women are currently incarcerated, and almost one third of Black men will be incarcerated at least once in their lifetime.4 Mass incarceration is thus potentially an important driver of the distribution of disease and ill-being in Black Americans.Tobacco is an integral part of prison culture, serving as a stress reliever, currency, and means of social interaction. Furthermore, the sensory and social deprivation of the prison environment may encourage tobacco use. Until the 1980s, cigarettes were freely distributed to incarcerated individuals as part of their rations and were (and still remain) the currency of choice for underground prison economies.5–7 However, tobacco policy in US prisons has changed radically in the past 25 years, culminating in the Federal Bureau of Prisons’ indoor smoking ban in federal prisons in 2004.8,9 Meanwhile, state and local prison and jail systems also modified their policies. By 2007, 87% of state prisons reported having either a total or indoor smoking ban in place, with none offering free tobacco.5As a population, people who have been incarcerated have a greater likelihood of having problems with substance abuse, psychiatric illness, and stressful or traumatic life events, potentially increasing susceptibility to nicotine addiction, with smoking prevalence in prison estimated at 40% to 80%.10–13 A systematic review of smoke-free policies in US prisons and jails that included 27 studies cited noncompliance with smoke-free policies ranging from 20% to 76% and demonstrated inconsistent implementation and control of contraband as well as the rise of tobacco black markets.14 In essence, if the available data are representative, the influence of underlying smoking norms seems to outweigh institutional policy changes, although the institutional setting may limit access and therefore consumption.In a systematic review, only 6 studies examining smoking postrelease from smoke-free prisons and jails were identified, and it indicated that individuals released went back to their previous smoking behavior almost immediately.14 With fewer constraints on consumption, individuals released from prison and jail may increase their cigarette consumption to achieve previous nicotine levels, especially those undergoing drug treatment or suffering from mental illness (and perhaps taking antipsychotics).15Even less is known about differences in incarceration-related tobacco smoking by race/ethnicity. Research shows that Blacks are less likely to participate and are not sampled in sufficient numbers to allow subgroup analyses.16,17 Controlling for socioeconomic status, Blacks have lower risk trajectories of cigarette smoking from childhood into adulthood than do Whites; they are also less likely to be heavy or regular smokers and more likely to be nonsmokers, initiating smoking later and reaching lower daily cigarette consumption.18–21 Although this lower tobacco consumption is one of the few health behavior advantages for Blacks compared with Whites, Blacks are more vulnerable to the health consequences of smoking (e.g., lung cancer).22 However, the role of incarceration in tobacco smoking prevalence among Blacks in the United States has not been examined.We therefore sought to evaluate the relationship between adult history of incarceration and tobacco smoking using a national sample of noninstitutionalized Black adults living in the United States, while taking account of differential propensity for having a history of incarceration.     

Enteroviruses as a possible cause of hypertension,dilated cardiomyopathy (DCM) and hypertensive heart failure (HHF) in South western Nigeria

Background

Human enteroviruses have long been associated with various diseases of man resulting into a wide range of acute symptoms involving the cardiac and skeletal muscles, central nervous system, pancreas, skin and mucous membranes.

Objective

To assess the role of enteroviruses in the etiology of hypertension, DCM and HHF.

Methods

We obtained stool specimens from 70 subjects comprising 65 patients and 5 controls and isolation was carried out on RD, L20B, HEp-2C and Vero cell lines and identified by neutralization with standard antisera (RIVM). Thirty-six enteroviruses were isolated and identified to be Coxsackieviruses-B5, A9, Echoviruses 1, 6, 7, 9, 11, 12, 22, 30 and Poliovirus type 1 and 3.

Results

Three most frequently occurring enterovirus serotypes which constitute 60.0% of the 30 NPEV typed and 50.0% of all the isolates were Echoviruses, Coxsackie-B5-virus and Coxsackievirus-A9. Echoviruses constituted 50.0% of all the serotypes while Coxsackieviruses-B5 and A9 accounts for the 27.8 % and 5.6% respectively. Enteroviral isolation rate was higher in age groups 51 years and above. The percentage of study subjects who had Coxsackie-B5-viruses and echoviruses was significantly (P<0.05) higher in cases of hypertension, HHF and DCM than in control subjects. Coxackie-B5-virus, Echovirus-6 and Echovirus-11 were found in both study locations.

Conclusion

The findings of this study showed that Enteroviruses may likely be involved in the etiology of hypertension, DCM and HHF. Further studies would therefore be necessary for the prevention and control of these diseases.     

Early diastolic functional abnormalities in normotensive offspring of Nigerian hypertensives

Background

Some studies have suggested that diastolic dysfunction precedes the clinical manifestation of hypertension. Whether changes in cardiac structure and function predate the clinical manifestation of hypertension later in life is now being investigated. The aim of this study was to assess the differences in cardiac structure and function between the offspring of hypertensive and normotensive parents.

Methods

Eighty normotensive offspring of hypertensive parents (OHyp) (41 females and 39 males) and 62 normotensive offspring of normotensive parents (ONorm) (31 males and 31 females) were recruited for echocardiography.

Results

The mean age was 25.0 (5.31) and 24.3 (3.60) years in the OHyp and ONorm participants, respectively (p = 0.369). Other baseline parameters were comparable between the two groups. Septal wall thickness in systole was higher in the OHyp than the ONorm subjects [1.3 (0.35) vs 1.1 (0.25), p = 0.0173]. Indexed left ventricular mass [28.1 (7.33) vs 27.5 (7.23), p = 0.631] and relative wall thickness [(0.3 (0.10) vs 0.3 (0.90), p = 0.280] were similar in the two groups. The offspring of hypertensives had lower deceleration time [149.9 (38.89) vs 169.0 (50.08) ms, p = 0.012], prolonged duration of pulmonary A reverse flow [113.5 (70.69) vs 81.7 (38.31) ms, p = 0.024], increased myocardial isovolumic relaxation time [173.4 (47.98) vs 156.1 (46.74) ms, p = 0.033] and a lower myocardial Em [0.2 (0.05) vs 0.3 (1.38), p = 0.037] and myocardial Em/Am ratio [1.6 (0.01) vs 2.1 (0.01), p = 0.019] than the offspring of normotensives.

Conclusion

This study showed that offspring of OHyp subjects had early diastolic functional abnormalities when compared with offspring of ONorm participants. Longitudinal studies are needed to determine the implications of this finding in this African population.     

Cardiomyopathies and myocardial disorders in Africa: present status and the way forward

Abstract

A review of heart diseases in Africa shows that the cardiomyopathies continue to be important causes of morbidity and mortality in the population. Hypertension remains the commonest cause of myocardial disease, followed by the cardiomyopathies. Ischaemic heart disease continues to be rare. Of the cardiomyopathies, dilated cardiomyopathy (DCM) is still the commonest. A large proportion of patients diagnosed with DCM in Africa have been shown to be cases of hypertensive heart failure, with varying degrees of myocardial dysfunction. Hypertrophic cardiomyopathy, which in the past was thought to be rare among Africans, has been shown to have the same prevalence as in other parts of the world. Moreover it is now known to be a genetic disorder. Endomyocardial fibrosis has become rare in communities where it used to be common. Its aetiology continues to be elusive. Arrhythmogenic right ventricular cardiomyopathy has been reported among Africans but there are no reports of left ventricular non-compaction or the ion channelopathies from Africa. Lenegre disease and the long-QT syndromes are well-known entities in clinical practice in Africa although long-QT in Africa is associated with potassium deficiency arising from prolonged treatment with diuretics. Left ventricular non-ischaemic aneurysms still occur but are rare. In view of these, a new classification of myocardial disorders was proposed for Africa.     

Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta,Nigeria: Data from the Abeokuta Heart Failure Registry

Heart failure (HF) has emerged as a global epidemic in at-risk populations, including those living in high-income countries and, as recently described, in low- to middle-income regions of the world, such as sub-Saharan Africa.11-4 While there are well-established HF registries to capture both the characteristics and health outcomes among those hospitalised with AHF in Europe,5,6 North America,7,8 and the Asia–Pacific region,3,9,10 there are few reports from sub-Saharan Africa.11 This includes Nigeria (the most populous country in the region), where HF has emerged as a potentially large public health problem.1Although there have been many therapeutic gains in the management of chronic HF,12 leading to improved overall survival rates,13 there has been very little parallel success (pending further evaluation of the recently reported RELAX trial14 with regard to AHF). This is particularly important when one considers the high proportion of patients who still require hospitalisation for acute HF, and associated high levels of in-patient case fatality and poor short- to medium-term health outcomes.Given the paucity of data describing health outcomes in unselected patients hospitalised with AHF in Nigeria (and indeed the wider sub-Saharan Africa), we examined short- (30 days) to medium-term outcomes (180 days) in consecutive subjects with AHF recruited into the Abeokuta HF registry over a period of six months. Standardised data collected via the registry were used to both describe the baseline characteristics of the cohort and identify correlates of mortality during the six-month follow up.     

Liver safety evaluation of endothelin receptor antagonists using HepatoPac®: A single model impact assessment on hepatocellular health,function and bile acid disposition

Marketed (bosentan, ambrisentan) and discontinued (sitaxsentan, CI‐1034) endothelin receptor antagonists were examined in the human micropatterned hepatocyte co‐culture (MPCC) model HepatoPac^®. Differences across hepatocellular health (cellular adenosine triphosphate/glutathione content), function (urea production/albumin secretion) and taurocholic acid transport (biliary clearance/excretion index) were compared using amiodarone and ciclosporin A as positive controls. Ambrisentan had the weakest potency in all six endpoints, while sitaxsentan, bosentan and CI‐1034 had more potent effects on hepatobiliary transport than health/function endpoints. Normalization to clinical C_max gave the following relative rank order of safety based on margins for each endpoint: ambrisentan ≥ CI‐1034 ~ bosentan > sitaxsentan. These data suggested impaired hepatobiliary disposition might contribute to a more prominent role in liver injury associated within sensitive human populations exposed to these compounds than direct hepatocellular toxicity. Rat, dog and monkey MPCCs also showed greater sensitivity potential to disrupted hepatobiliary disposition compared with hepatocellular health/functional endpoints. Drug metabolism competency was exhibited across all species. In vivo, rats and dogs appear more resistant to transaminase elevations and/or histological evidence of liver injury caused by these mechanisms even at exceedingly high systemic exposures relative to sensitive humans. Rats and dogs are resistant to hepatobiliary toxicants due to physiological differences in bile composition/handling. Although traditional animal testing provides adequate safety coverage for advancement of novel pharmaceuticals into clinical trials, supplemental assays employing human MPCCs may strengthen weight‐of‐evidence predictions for sensitive human populations. Proving the predictive value of this single impact assessment model in advance of clinical trial information for human liver injury risk is needed across more pharmaceuticals.     

Ileosigmoid knotting in patients under 25 years of age: A report of two cases

INTRODUCTION

Ileosigmoid knotting is a rare cause of acute abdomen with high morbidity and mortality. Its diagnosis is infrequently made before surgery because of its varying ways of presentation and rarity.

PRESENTATION OF CASE

The first was a 21-year-old male who presented with a history of sudden generalized abdominal pain and progressive abdominal distension. He was pale and severely dehydrated. His extremities were cold and clammy. His pulse rate was 110 per minute and blood pressure was 90/50 mmHg.The second case was 20-year-old male who presented with similar symptoms as above. He was not pale but mildly dehydrated. His pulse rate was 92 per minute and blood pressure 110/70 mmHg.Both patients were resuscitated and had exploratory laparotomy a few hours after presentation. The first patient was found to have ileosigmoid knotting with gangrenous sigmoid colon and terminal ileum. He had Hartmann''s procedure and right hemicolectomy with ileo-transverse anastomosis.The second patient was found to have ileosigmoid knotting with viable loops of bowel. He had careful detorsion, sigmoidectomy with primary anastomosis. Both patients’ have good outcome.

DISCUSSION

This is to report two cases of ileosigmoid knotting in two male patients aged 21 and 20 years, respectively, with the hope of increasing awareness.

CONCLUSION

Ileosigmoid knotting though more common in fourth or fifth decade of life, can also occur in the 2nd decade. Early diagnosis, careful resuscitation and skilful surgical intervention will improve outcome.     

Death during coronary angiography in a woman with cardiac amyloidosis.

Amyloidosis is a well-recognized systemic disease entity. Patients with cardiac amyloidosis have a poor prognosis; the median survival time after development of congestive heart failure is 4 months. We describe a 72-year-old woman with unsuspected cardiac amyloidosis who died during diagnostic coronary angiography. To our knowledge, this is the first report of this complication.