High rate of Hepatitis B virus infection among hairdressers in Ibadan,Nigeria

Hepatitis B virus (HBV) infection is a major public health problem for over two billion people infected globally. Occupationally exposed persons are at high risk of HBV infection and, apart from medical personnel, there is dearth of information concerning the prevalence and awareness of HBV among this population in Nigeria. This study was designed to determine the levels of HBV awareness and prevalence of HBV infection among hairdressers in Ibadan, Nigeria. Hairdressers and teachers (unmatched controls) in four local government areas in Ibadan were tested for HBV infection using ELISA technique. Dried blood spot (DBS) samples were collected from 171 participants. DBS elutes from the samples were tested for HBV surface antigen (HBsAg). The rate of HBV infection was higher (p = 0.005) among the hairdressers (13.0%) than teachers (4.8%). However, teachers were better informed about HBV (38%) compared to hairdressers (13%; p = 0.0001). Differences in HBV awareness and occupation type were found to be significant (P = 0.001). Hairdressers are at high risk of HBV infection and may constitute a major source of HBV spread among urban dwellers, especially in areas where awareness is low. Routine HBV screening and appropriate interventions for hairdressers are recommended to interrupt HBV transmission.     

Adverse relationships of adiposity and gait parameters: A survey of stroke patients undergoing rehabilitation

Poor adiposities are risk factors for major morbidities, but reports on how these relate with gait function of stroke patients undergoing rehabilitation is sparse and need further investigation. A convenience sample of 94 ambulatory stroke survivors and 94 matched apparently healthy individuals were assessed for adiposity markers (body mass index, waist circumference, thigh girth, waist-hip ratio, and percent body fat) and gait parameters (cadence, step length, stride length, stride width, gait velocity, and cycle). Mean age of the stroke and apparently healthy participants were 57 ± 5.2 years and 56.9 ± 4.8 years, respectively. We found significant (p < 0.05) relationships between waist circumference and each of gait cycle (r = 0.67) namely, cadence (r = −0.68), stride length (−0.62), step length (−0.61), and gait velocity (−0.75). Fairly similar correlations existed between body mass index, waist-hip ratio, percent body fat, thigh girth, and each of gait parameters, with only the thigh girth significantly correlating with stride width (r = 0.79). Obesity more than triples the odds of low gait velocities (odds ratio: 3.28; 95% confidence interval: 1.60–6.74). Findings provide clinicians with likely influence of adiposities on gait parameters of stroke patients. This may inform treatment decision and help to prioritize interventions through adiposity management for stroke patients undergoing rehabilitation.     

Sonographic guided hydrostatic saline enema reduction of childhood intussusception: a prospective study

Background

The management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution.

Materials and methods

A prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction.

Results

The age range was 3 months to 48 months with a mean of 10.8?±?9.1 months. Forty percent (N?=?18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N?=?38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p?>?0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p?=?0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment.

Conclusion

Our study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.

     

Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states

Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players’ capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players’ support largely depends on how well the reform aligns with political structures and current institutional practices.     

Severe road traffic injuries in the third trimester of pregnancy

We report 9 women in the third trimester of pregnancy who were severely injured in road traffic accidents. There were 3 accelerated labours and half the babies died. Immediate obstetric interference was often impractical and did not improve fetal survival. Noteworthy injuries of the central nervous system were associated with very high fetal mortality. Fractures of the pelvis were not nearly as disastrous as the literature suggests. The first consideration in management should be the well being of the severely injured mother, since the injuries that would kill the fetus are not likely to be amenable to surgery. The only justification for intervention for the sake of the fetus that survives the moment of impact is to salvage it from its dying mother's body.     

Quantitative tract-specific measures of uncinate and cingulum in major depression using diffusion tensor imaging

Previous findings suggested the role of the prefrontal cortex, hippocampus, and cingulate gyrus in major depressive disorders (MDD), but the white matter microstructural abnormalities of the fibers connecting these brain structures are not known. The purpose of this study was to test the hypothesis that white matter abnormalities are present in association fibers of the uncinate fasciculus (UF) and cingulum bundle (CB) among MDD subjects. A total of 21 MDD subjects aged between 30 and 65 years and 21 age-matched healthy controls (HC) were recruited. All subjects were right-handed and without history of diabetes or other cardiac diseases. We extracted quantitative tract-specific measures based on diffusion tensor imaging tractography to examine both diffusivity and geometric properties of the UF and CB. Significantly decreased fractional anisotropy (FA) and increased radial diffusivity of the right UF were observed in MDD patients compared with HC (p<0.05), while their geometric characteristics remained relatively unchanged. Among MDD subjects, depression severity had a significant negative correlation with normalized number of fibers (NNF) in the right UF (r=-0.53, p=0.02). We also found significant age effect (oldR) in both groups in the FA measure of the CB. Our study demonstrates novel findings of white matter microstructural abnormalities of the right UF in MDD. In the MDD group, the severity of depression is associated with reduced NNF in the right UF. These findings have implications for both clinical manifestations of depression as well as its pathophysiology.     

AKT proto-oncogene overexpression is an early event during sporadic colon carcinogenesis.

The inhibition of apoptosis is a critical event in the development of colorectal malignancies, although the mechanism(s) remain incompletely understood. The anti-apoptotic proto-oncogene, AKT, has been implicated in the molecular pathogenesis of a variety of human malignancies; however, no data exist on the role of AKT in colon carcinogenesis. We therefore evaluated the presence of AKT in human and experimental colon neoplasms by immunohistochemistry. Normal colonic mucosa and hyperplastic polyps exhibited no significant AKT expression, in marked contrast to the dramatic AKT immunoreactivity seen in colorectal cancers (57% positive) and in both human colorectal cancer cell lines examined. Importantly, AKT was also detected in 57% of the adenomas examined, implicating overexpression of this proto-oncogene as an early event during colon carcinogenesis. Moreover, in the rodent-carcinogen model, azoxymethane (AOM)-treatment induced AKT expression in premalignant rat colonocytes. Tumors that evolve via different genetic pathways displayed a lower incidence of AKT overexpression. Indeed, only 22% of mismatch repair defective tumors and 42% of AOM-induced rodent tumors upregulated AKT. Staining with an antibody specific for AKT 2 duplicated findings with the AKT 1&2 antibody, suggesting that AKT 2 was the predominant isoform involved in colon carcinogenesis. Furthermore, utilizing an antibody that specifically recognizes the serine-473 phosphorylated form of AKT, we observed that activated AKT was detectable in the neoplastic but not normal epithelium. In summary, our immunohistochemical analysis indicates AKT overexpression occurs frequently during human colon carcinogenesis, but is less common in colon cancers with microsatellite instability. The early inhibition of apoptosis during sporadic colon carcinogenesis may be related, at least partly, to the overexpression of AKT.     

Characterization of tinnitus in Nigeria

Objective

This study aimed to characterize tinnitus in middle aged and elderly out-patients attending a specialized clinic in a developing country.

Methods

A cross sectional study of patients attending the ear, nose and throat (ENT) clinic of Olabisi Onabanjo University Teaching Hospital, OOUTH Sagamu, Nigeria. Data was collected with the use of a structured questionnaire. Data collected included socio demographics, medical history including experience of tinnitus, PTAs, BMI and BP. Data was analyzed using SPSS version 17.0.

Results

79 patients had complaints of tinnitus thus making a crude prevalence of 14.5%, the prevalence increased steadily along the age groups. 51.9% of patients experienced tinnitus for a short period. 53.2% of the patients had symptoms referable to only one ear, while 54.4% had discrete as opposed to multiple types of tinnitus. Occurrence of intermittent symptoms was experienced by 75.9% of the patients and 70.9% were non-pulsatile in nature. Tinnitus was significantly associated with abnormal audiographic pattern, global increased hearing thresholds, high tone hearing loss, vertigo, hypertension and obesity.

Conclusion

Tinnitus character was majorly short term, unilateral, discrete, intermittent, and non-pulsatile in nature, and it is associated with otological, audiological, anthropometric and cardiovascular anomalies. The characteristics of tinnitus in Nigerian patients were similar to those described in developed countries, but the major risk factors for tinnitus except hearing impairment, may be different from the latter.