Medical mortality in an emergency department in Nigeria: the transition is obvious!

IntroductionThe emergency department (ED), a major entry point into the hospital, provides an insight to the type of cases seen, the quality of care and mortality spectrum in a health institution. We aim to identify the spectrum of medical causes of mortality in our ED, the demographic pattern and duration of stay before death.MethodThis is a retrospective study that looked at medical mortality in the ED from January 2004 to December 2009. We obtained data on the demographics and causes of death from the medical records and case notes of the deceased.ResultsA total of 16587 patients were admitted during the period under review, of these 1262 (7.61%) died in the ED. The male to female ratio was 1.58:1.0 [772 males (61.2%), and 489 females (38.8%)]. Mortality was highest among the 20–45 years age range, followed by 46–65 years, >65 years and < 20 years in decreasing frequency [589(46.7%), 421(33.4%), 186 (14.8%) and 66(5.2%) respectively]. The three most common causes of death were stroke 315(25%), HIV related illnesses 126(10.0%), and heart failure 123(9.7%). Most deaths occurred less than 24hours of admission, 550(43.6%), followed by one day (36.0%) and two days (10.8%) post admissions respectively.ConclusionThe commonest cause of death in the ED was stroke. The burden of death was highest in the younger age group, with most occurring less than 24 hours of admission.     

Human Rotavirus Group a Serotypes Causing Gastroenteritis in Children Less Than 5 Years and HIV-Infected Adults in Viwandani Slum,Nairobi

Background

Rotavirus remains a leading cause of acute gastroenteritis in children worldwide with an estimated 2000 deaths each day in developing countries. Due to HIV/AIDS scourge in Kenya, it is possible that rotavirus-related gastroenteritis has been aggravated in adults. The Global Alliance for Immunizations has ranked rotavirus infection a priority for vaccine, and, to ensure its success, there is a need to document the local strain(s) circulating in different regions.

Methods

A cross-sectional study was conducted to document human rotavirus group A serotypes in children below 5 years and HIV-infected adults in Viwandani slum in Nairobi, Kenya. A total of 260 (128 from children and 132 from HIV infected adults) fecal specimen samples were analyzed from August 2012 to July 2013. Screening for rotavirus was done by antigen based enzyme immune-sorbent assay (ELISA), Polyacrylamide gel electrophoresis (PAGE) was used to detect rotavirus electropherotypes and finally genotyping was done by RT-PCR using genotype-specific primer sets targeting VP4 and VP7 genes.

Results

Rotavirus was detected in 23% and 8% of children and adult, respectively. Prevalence was high in children of < 2 years and adults of > 48 years. Long electropherotypes accounted for 80% and 60% while short electropherotypes accounted for 20% and 40% in children and adult, respectively. The common globally distributed strains, G1 and G3, accounted for 60% detections while the unusual G9 strain accounted for 80% infection in adults. G1P[8] was the common genotypic combination in children, accounting for 40% infection, whereas G9 [P8] accounted for 60% of the infections in adults.

Conclusion

This study shows the existence of strain diversity between rotavirus circulating in children and adults within this study group. It further shows that as currently constituted, the 2 vaccines recommended for rotavirus would cover the circulating strain in Viwandani slum. Finally, there is a need for continuous rotavirus strain surveillance in children and a further focus on HIV infected adults.     

IL-6 and IL-8 levels in GCF of the teeth supporting fixed partial denture

Objectives:  To evaluate the gingival crevicular fluid (GCF) contents of interleukin-6 (IL-6) and interleukin-8 (IL-8) and the clinical parameters of the teeth supporting fixed partial denture (FPD) and the contralateral teeth and to assess the effect of scaling and root planning (SRP) on clinical parameters and the GCF levels of cytokines.
Materials and methods:  The study population included 23 patients. Probing depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI) were recorded, and GCF samples were collected for analysis of cytokine levels from the teeth with FPD (Test Group), the contralateral teeth (Control Group) of each participant at baseline. After initial measurements, all participants received primary phase of non-surgical treatment including oral hygiene instruction and scaling and root planning (SRP). At the 1st month and the 3rd month after SRP, these procedures were repeated.
Results:  In both groups, all clinical parameters and the total amount of IL-8 showed decreases from initial to the 3rd month ( P  < 0.05), but from the 1st month to the 3rd month; PD, PI, and GI values significantly increased in the test group ( P  < 0.05).
Conclusion:  The non-surgical periodontal treatment reduced the total amount of IL-8, not IL-6, and the clinical parameters of the teeth with FPD and contralateral teeth. But, there was a trend to the higher levels of PD, PI, and GI in the teeth with FPD. Therefore, a regular program for dental prophylaxis is also important for the maintenance of periodontal health in patients with FPD.     

Prognosis for infants weighing 1000 g or less at birth

During the 10 years 1966-1975, 148 infants weighing less than or equal to 1000 g were admitted to the Neonatal Unit of University College Hospital. 48 (32%) survived the neonatal period. The neonatal survival rate for infants weighing less than or equal to 750 g was 8% and for infants weighing 751-1000 g, 41% 9 infants died later, leaving 39 (26%) long-term survivors, all of whom are being followed-up. The progress of the 27 older children, born in 1966-74 (median birthweight 899 g, range 648-998 g; median gestational age 28 weeks, range 24-35 weeks), was assessed at ages between 15 months and 8 years (median 3 years). No abnormalities were detected in 21 infants (78%): 2 (7%) had major handicaps and 4 (15%) minor handicaps. We conclude that provided intensive care methods are available, the prognosis for infants weighing less than or equal to 1000 g is now better than in the past.     

酶联免疫吸附试验测定血清内源性哇巴因

目的建立血清内源性哇巴因（ＥＯ）浓度测定的酶联免疫吸附试验，促进对这一新的皮质类固醇激素的研究。方法利用外源性哇巴因免疫家兔制备哇巴因抗血清，用棋盘试验确定抗血清的稀释度及包被抗原的浓度；进行灵敏度、精密度、回收率、特异性试验。结果以抗血清稀释度为１：１００００、包被抗原浓度为１μｇ／ｍｌ时标准曲线最理想，灵敏度为０．２３μｇ／Ｌ，血清ＥＯ高（２．４μｇ／Ｌ）、中（１．２μｇ／Ｌ）、低（０．６μｇ／Ｌ）浓度的平均批内变异系数为４．７％，批间变异系数为１２．３％；高、低浓度的回收率分别为９６．３％和９１．４％；与肾上腺素、去甲肾上腺素、血管紧张素Ⅱ、醛固酮、氢化可的松及地塞米松无交叉结合反应，与地高辛存在１．８％的交叉反应。用该法测定正常人（１０例）、孕妇（２３例）及原发性高血压患者（１０例）血清ＥＯ含量分别为０．５１±０．１７、０．８１±０．２６、０．７４±０．２０μｇ／Ｌ。结论该方法具有方便、快速、准确、特异和成本低的优点，可用于对内源性哇巴因的临床与实验研究。     

Living conditions of children at risk for noma: Nigerian experience

The study reported in this paper was carried out in the Northwestern and Southwestern regions of Nigeria, between October 1996 and April 1998. The study examined the possible contributory role of living conditions in the development of acute necrotizing gingivitis (ANG) or noma from oral lesions. Questionnaire data obtained from 42 fresh noma cases seen in the Northwest and four fresh cases seen in the Southwest were examined. In addition 46 cases of advanced ANG from the Southwest were included. The main focus was to compare some of the environmental living conditions of cases with advanced ANG and those with noma in these regions. All the noma and ANG cases were seen in children aged 2-12 years. The level of good oral hygiene practices and general environmental living conditions were significantly higher in the Southwest than in the Northwest. Data also showed that living in close proximity with livestock was significantly higher in the Northwest than in the Southwest (P < 0.05). The environmental living conditions of children in the Northwest were further compounded by poor sanitary faecal disposal practices as well as minimal access to potable water. The overall data indicated that living in substandard accommodations, exposure to debilitating childhood diseases, living in close proximity to livestock, poor oral hygiene, limited access to potable water and poor sanitary disposal of human and animal faecal waste could have put the children in the Northwest at higher risk for noma than the children in the Southwest. These could have been responsible for the higher prevalence of noma in the Northwest than in the Southwest.     

The Novel Antihyperglycaemic Action of Hunteria Umbellata Seed Fractions Mediated Via Intestinal Glucose Uptake Inhibition

The present study evaluated the antihyperglycaemic effect and mechanism of action of fractions of the aqueous seed extract of Hunteria umbellata (K. Schum.) Hallier f. (HU) in normal and alloxan-induced hyperglycaemic rats. HU was partitioned in chloroform, acetyl acetate and butan-1-ol to give chloroform fraction (HU_c), ethyl acetate fraction (HU_e), butanol fraction (HU_b) and the “residue” (HU_m), respectively. 200 mg/kg of each of these fraction dissolved in 5% Tween 20 in distilled water was investigated for its acute oral hypoglycaemic effects in normal rats over 6 hours while its repeated dose antihyperglycaemic effect was evaluated in alloxan-induced hyperglycaemic rats over 5 days. In addition, 50 mg/kg of the crude alkaloid fraction (HU_Af) extracted from HU was evaluated for its possible antihyperglycaemic activity in alloxaninduced hyperglycaemic rats using oral glucose tolerance test (OGTT) over 6 hours. Using the solvent system, distilled water-butanol-ammonium hydroxide (2:15:1, v/v/v), HU_b was chromatographed and stained with Dragendorff''s reagent for confirmatory qualitative analysis for alkaloids. Results showed that oral pre-treatment with 200 mg/kg of HU_e, HU_b and HU_m resulted in a significant (p<0.05, p<0.001) time dependent hypoglycaemic effect, with the butan-1-ol fraction HU causing the most significant (p<0.001) hypoglycaemic effect. In the alloxan-induced hyperglycaemic rats, repeated oral treatment with 200 mg/kg of same HU fractions for 5 days resulted in significant (p<0.05) decreases in the fasting blood glucose concentrations with the most significant (p<0.01) antihyperglycaemic effect also recorded for HU_b. Similarly, oral pretreatment with 50 mg/kg of HU_Af significantly (p<0.05, p<0.01 and p<0.001) attenuated an increase in the post-absorptive glucose concentration at 1^st – 6^th h in the alloxan-induced hyperglycaemic OGTT model. In addition, alkaloid was present in most of the separated spots on the TLC plate. In conclusion, results of this study showed that HU contains a relative high amount of alkaloids which could have accounted for the antihyperglycaemic action of HU that was mediated via intestinal glucose uptake inhibition.     

Regional differences in the vasorelaxant effects of nicorandil and amlodipine on isolated porcine coronary arteries

Summary— The vasorelaxant effects of nicorandil, a K⁺-channel opener, and amlodipine, a dihydropyridine-type Ca²⁺-channel blocker, were investigated on partially and maximally K⁺-depolarized ring preparations from the porcine left anterior descending coronary artery. By comparing vascular responses in the proximal and distal parts of the epicardial segment, the scope of the study was to evaluate regional differences in the action of nicorandil and amlodipine. Nicorandil (10 ⁷- 10^-4 M) shifted the K⁺ concentration-response curves to the right and depressed the maximal contractile responses in a concentration-dependent manner, consistent with K⁺-channel opening and secondary non-K⁺-channel opening mechanisms of action. Nicorandil had a significantly more potent relaxant effect in the proximal compared to the distal arterial rings contracted with 85 mM K⁺. Pretreatment with methylene blue (10^-5 M) did not significantly influence the regional difference in the action of nicorandil. Amlodipine (10⁹- 10^-6 M) had a significantly more potent and effective inhibitory and relaxant effect than nicorandil under the same conditions. In contrast to nicorandil, the effect of amlodipine was more prominent in the distal compared to the proximal vessel rings. The cumulative addition of extracellular Ca²⁺ exhibited a more potent contractile response in the distal rather than in the proximal rings. Nicorandil totally and amlodipine partly eliminated the contractile responses to the lowest concentration of Ca²⁺. The inhibitory effect of amlodipine on the contractile responses to higher Ca²⁺ concentrations was more pronounced than that of nicorandil. The results show that there are regional differences in the responsiveness of porcine coronary arteries to Ca²⁺, nicorandil and amlodipine. Our findings indicate that the regional difference in nicorandil-induced vasodilation was caused neither by the K⁺-channel opening nor by the nitrate-like mechanism of action, but could be due to a direct Ca²⁺-influx blocking effect of the drug.