Boerhaave's syndrome presenting as tension pneumothorax.

Boerhaave's syndrome can present initially as a case of tension pneumothorax. Mortality rate with delayed treatment is very high, therefore diagnosis should be made rapidly in the emergency department. Multidisciplinary cooperation, immediate radiological confirmation, prompt aggressive resuscitation, and surgical intervention offer the best chance of survival.     

Urinary output during induced labour in normotensive women: a prospective pilot study.

All fluid intake and urine output were monitored and measured in 103 consecutive women with normal blood pressure and without a history of pre-existing renal disease during induced labour for various indications. Epidural analgesia was administered in all these women and labour was augmented with oxytocin infusion. All urine specimens passed were tested for specific gravity.The temperature of the labour rooms was between 25 and 27 degrees C. Analysed results (from 50 women) shows that at a mean fluid intake of 75 ml/hour (standard deviation (SD) 21.84), oliguria (urine output <30 ml/hour) occurred in 42 (84%) of the women. There was a positive correlation between fluid intake and urinary output (r(2)=0.8515, P<0.0001). Urinary specific gravity was high (>1010) in all the specimens throughout the study. This study suggests that oliguria may be a common component of labour managed in this manner and its interpretation in pre-eclamptics in labour may be viewed in this context. Oliguria may therefore be a poor indicator of renal function or worsening pre-eclampsia during labour and its management needs to be limited to the severe and persistent variety to avoid renal complications. We believe from this study that relevant urine and blood biochemistry are better correlates of renal function in labour.     

Bone metabolism and the 10-year probability of hip fracture and a major osteoporotic fracture using the country-specific FRAX algorithm in men over 50 years of age with type 2 diabetes mellitus: a case–control study

The aim of the study was to evaluate the 10-year probability of hip fracture and a major osteoporotic fracture using the FRAX algorithm, vitamin D status, bone mineral density (BMD), and biochemical markers of bone turnover in men over 50 years of age with type 2 diabetes mellitus (T2DM). We estimated FRAX-predicted 10-year fracture probability, levels of 25-hydroxyvitamin D (25-OH-D), markers of bone turnover, and bone mineral density at the L1–L4 (lumbar spine (LS)) and femur neck (FN) in 68 men with T2DM and compared these with an age-matched group (n?=?68). The mean (range) age of the T2DM group was 61.4 (51–78)?years. The prevalence of hypovitaminosis D (25-OH-D <75 nmol/L) was 59 %. The mean (range) FRAX hip fracture and FRAX major osteoporotic fracture was 0.7 (0–2.8) and 3.2 (0–8.5)?%, respectively. BMD at the FN (0.974 vs. 0.915 g/cm², p?=?0.008) and LS (1.221 vs. 1.068 g/cm², p?<?0.001) was significantly higher in the T2DM cohort as compared to the healthy age-matched males. 25-OH-vitamin D (67.7 vs.79.8 nmol/L, p?<?0.001), crosslaps (0.19 vs. 0.24 μg/L, p?=?0.004), and osteocalcin (13.3 vs. 15.7 μg/L, p?=?0.004) were significantly lower in the T2DM group. There was no difference in FRAX-related fracture probability between the two groups. Acknowledging the limitations of our study size, we suggest that the increased BMD in T2DM and the noninclusion of T2DM as a secondary risk factor in the FRAX algorithm may be probable explanations for the discordance between literature-observed and FRAX-related fracture probabilities.     

Twenty‐first century palliative care: a tale of four nations

Hospice and palliative care development, in terms of availability and services, occur to varying degrees in the developing world. In this paper, the evolution of palliative care practices in four developing nations (Nigeria, Georgia, Ethiopia and Tanzania) is described. By highlighting common problems as well as the unique individual perspectives of each country's practice, this paper aims at increasing global awareness of palliative care in the developing world. While the call for palliative care to become a fundamental human right is sustained, it is also hoped that this article will stimulate a global discussion on the best possible way to encourage the establishment and growth of palliative care services in other developing countries where hitherto it has not been in existence, with policymakers and healthcare professionals taking the lead through the institution of sound national policies to promote and provide palliative care to all citizenry.     

Local knowledge and attitudes about onchocerciasis in Oji-River local government area of Enugu State,Nigeria

A total of 556 individuals in Agbalenyi Community of Oji-River local government area of Enugu State, Nigeria were studied using questionnaires, focus group discussions and key informant interviews to determine the socio-cultural factors affecting the transmission of onchocerciasis. The result revealed a low level of knowledge about the cause, prevention and complications of onchocerciasis. Respondents have developed a cultural system around the disease due to long exposure. The majority are aware of the disease which they recognize once their body starts itching or musculoskeletal pain develops but only 64.4, 34.0, 1.4 and 3.6%, respectively attributed chronic itching, nodules, bad vision and leopard skin to blackfly bite. Other perceived causes mentioned include ageing, the type of food eaten, farm work and 'bad blood'. Only 0.8% knew diagnosis could be made through skin snips. Neither Oji-River nor any of the river systems were associated with any of the complications of onchocerciasis. Significant differences in most socio-demographic characteristics were associated with differences in the level of knowledge about the disease.     

Maternal and child dietary patterns and their determinants in Nigeria

Understanding the overall dietary patterns of a population is a key step in initiating appropriate nutritional interventions and policies. Studies characterising the dietary patterns of Nigerian mothers and children are lacking. Complete dietary data for 13 566 mothers and their 13 506 children were analysed from the 2008 Nigerian Demographic and Health Surveys (NDHS), a nationally representative sample, to identify the overall maternal and child dietary patterns and to study the potential determinants of such dietary patterns. The 2008 NDHS included questions that inquired about the food items mothers and their children had consumed during the 24 h preceding the day of the interview. Factor analysis with the principal component procedure was used to construct the dietary patterns, and multiple multilevel logistic regression was used to investigate the determinants of the dietary patterns. Four (‘mixed’, ‘traditional’, ‘staple foods and milk products’ and ‘beverages’) and five (‘mixed’, ‘selective’, ‘beverages and candies’, ‘gruels, grains and semi‐solids’ and ‘infant formula and cereals’) distinct dietary patterns were obtained for the mothers and children, respectively. The key determinants of both maternal and child dietary patterns were month of interview, religion, region of residence, maternal education, maternal occupation, wealth index and maternal body mass index. Marital status additionally predicted maternal patterns, while sex of the child, number of siblings, child's age, maternal age and place of residence additionally determined the child's patterns. This study has identified four and five different dietary patterns to characterise the dietary habits of Nigerian mothers and their children, respectively, and has shown the important socio‐economic/demographic factors influencing the dietary patterns, which can guide appropriate nutritional interventions among Nigerian mothers and children.     

Experience of child welfare services and long-term adult mental health outcomes: a scoping review

Purpose

This is the first comprehensive review of empirical research that investigated the association between receipt of child welfare services and adult mental health outcomes. The review summarised the results of studies about mental health outcomes of adults with a history of child welfare involvement.

Methods

A scoping review methodology was used to search five electronic databases (MEDLINE, EMBASE, PsychINFO, IBSS, Social Policy and Practice). Studies were included if they examined any child welfare exposure (including receipt of services while remaining at home/being placed in care) and adult mental health status.

Results

In total 4591 records were retrieved, of which 55 met the eligibility criteria. Overall, receipt of child welfare services was associated with an increased risk of adult mental ill-health, suicide attempt and completed suicide. Results regarding potential moderating factors, such as gender and care-related experiences, were mixed. Relatively few studies investigated the reasons for requiring child welfare services, the experience of abuse or neglect or the adult outcomes of child welfare service users who remained in their own homes. Mental ill-health was defined and measured heterogeneously and details about the nature and type of welfare service utilisation were lacking.

Conclusion

There is a need for detailed, longitudinal studies to better understand the relative contribution of pre-existing adversity versus experiences during and after exposure to child welfare services on adult mental health outcomes. More standardised measures of mental ill-health and greater detail from authors on specific care exposure are also needed.

     

Pain research in Africa: a ten-year bibliometric survey

Purpose

Over the years, a trend for very low numbers of scientific publications from Africa has emerged. There has been no evaluation of pain research publications from this region. This study was conducted to determine the African pain research spectrum over the last 10 years, to identify trends in the number of publications from different countries, to identify currently underexplored areas of pain research, and to stimulate renewed interest in quality pain research in Nigeria and Africa.

Methods

The English- and non-English-language medical literature on pain from July 2002 to May 2012 was studied using Medline, the Ovid database, and by performing hand searches of relevant references using Google. Publications on pain by Africans and/or non-Africans conducted in Africa on Africans living in Africa within the study period were included. The total number of articles per country, publication types, and impact factors of the respective journals were tabulated to determine the quantity and quality of research in this field.

Results

Two hundred twenty-eight (228) articles from 25 African countries that were published in 129 different journals were identified. The majority were epidemiological studies (43.9 %), experimental studies (20.2 %), randomized controlled trials (2.2 %), and systematic reviews (1.8 %). Nigeria, South Africa, and Uganda topped the list of the most-published articles, with 76 (33.3 %), 71 (31.1 %), and 12 (5.3 %), respectively. The total number of journals with impact factors was 81, of which 29 were high-impact-factor journals.

Conclusion

Pain research publications from Africa should be encouraged. Given the underexplored frontiers of pain research, there is a need to engage in rigorous research in this field to enhance the contribution of the African continent (“the African Voice”) to worldwide advances in this respect.