Effect of exchange blood transfusion on oxygen saturation of neonates with severe neonatal jaundice by pulse oximetry

Objective: To determine if there was any difference in SpO2 readings during exchange blood transfusion (EBT).Methods: A prospective cross-sectional study of neonates with severe neonatal jaundice requiring EBT was conducted. Oxygen saturation was recorded before, immediately and 15 minutes after EBT by using a pulse oximeter. Results: This study included 30 neonates with 20 males and 10 females. The age ranged from 1 to 12 days with a mean of (5.4 ± 2.9) days. Pre-EBT SpO2 ranged from 90％ to 98％ with a mean value of (94.3 ± 2.2)％; SpO2 in the end of EBT ranged from 85％ to 99％ with a mean value of (94.1 ± 3.2)％; SpO2 at 15 minutes after EBT ranged from 77％ to 99％ with a mean value of (94.8 ± 4.1)％. There was no significant difference between SpO2 values at onset of EBT and either immediately or 15 minutes after EBT (P=0.770 and 0.422, respectively). SpO2 showed no significant difference between neonates who were infused with blood of different storage times (<24 h or ≥24 h) at the onset of EBT (P=0.584), immediately (P>0.999) and 15 minutes after EBT (P=0.887). Besides, SpO2 values were compariable in neonates with hematocrit <45％ or ≥45％ at the onset of EBT (P=0.284), immediately (P=0.118) and 15 minutes after EBT (P=0.868). Conclusions: EBT does not affect SpO2 in neonates.     

Esthesioneuroblastoma: An Update on the UCLA Experience, 2002–2013

Objectives To profile the clinical presentation and treatment results of esthesioneuroblastomas at the University of California, Los Angeles (UCLA), from 2002 to 2013. Design Retrospective review. Setting Tertiary academic institution. Participants Forty-one patients with esthesioneuroblastomas treated at UCLA. Main Outcome Measures Overall survival (OS) and recurrence-free survival (RFS). Results Thirty-six patients were included with a mean age of 50.1 years and a median duration of follow-up of 33 months. The 5-year RFS and OS were 54% and 82%, respectively. Modified Kadish stage was the only factor identified to affect OS. Multivariate analysis demonstrated that tumor grade was the only factor that had an independent impact on RFS. There was no statistical difference in survival among the surgical approaches chosen. Conclusions The updated data on the UCLA experience reveals that all three surgical approaches chosen provide comparable survival, although longer follow-up will be needed to ascertain if these findings hold true. The endoscopic approach had a statistically significant decrease in length of hospital stay and a trend toward reduced blood loss, intensive care unit admission, and complications. The modified Kadish staging was the only factor identified to predict OS. Multivariate analysis revealed that tumor grade was an independent predictor of recurrence; therefore, its importance should be emphasized in future staging systems.     

Medical ethics in sub-Sahara Africa: closing the gaps

Background

Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices.

Objectives

To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria.

Methods

A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues.

Results

A total of 307(76.2%) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether “Ethical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to “patient''s wishes”, on the other hand over two-third of the respondents 211 (68.7%) agreed that “doctor should do what is best” irrespective of the patient''s opinion. There were significant differences (p<0.05) between the perception of physicians and non-physicians on many ethical issues.

Conclusion

This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals.     

Suicide risk among adults with epilepsy in Kaduna,Nigeria

Objective

There is paucity of information on epilepsy and suicide in Nigeria. The objective of this study therefore was to assess the prevalence and determinants of suicide risk among adults with epilepsy (AWE) in Kaduna, Nigeria.

Method

We administered the suicidality module of the Mini International Neuropsychiatric Interview, the three-item Oslo Social Support Scale and the Hospital Anxiety and Depression Scale to 170 consecutive AWE attending the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna, between January and June 2011 to determine the prevalence of suicide risk, the level of social support and the psychological symptoms, respectively. We also recorded the sociodemographic and clinical characteristics of the subjects.

Results

There are 99 males and 71 females. The subject’s mean age was 28.7±12.1 years. The prevalence of suicide risk was 20.0%. Short seizure-free periods (χ²= 4.658, P= .031), previous suicide attempts (χ²= 12.216, P< .001), anxiety symptoms (χ²= 5.075, P= .024) and depressive symptoms (χ²= 5.093, P= .016) were significantly associated with suicidal tendencies. However, after a logistic regression analysis, none of the above variables predicted suicide risk.

Conclusion

Suicide risk is common among AWE. Poor seizure control, previous suicidal attempts and emotional distress are associated factors.     

Risk of second primary malignancy in patients with sinonasal tumors: a population‐based cohort study

Background

The 5‐year overall survival rate for patients with sinonasal cancers has remained around 50% for the last 3 decades. Prior studies on head and neck cancers have suggested that 1 reason for poor survival is the frequent development of second primary malignancies (SPMs). The purpose of this study is to assess overall and site‐specific risks of SPM following treatment of sinonasal malignancy.

Methods

A retrospective, population‐based cohort study was performed on 2614 patients in the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with primary sinonasal malignancy between 1973 and 2014. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated to assess risk of SPM relative to incidence in the general population.

Results

A total of 422 (16.1%) patients with primary sinonasal malignancies developed a total of 480 SPMs. This cohort had a significantly higher frequency of SPMs than expected in the general population (SIR 1.32; 95% confidence interval [CI], 1.20 to 1.44; AER 53.41). Site‐specific analyses of SIRs suggested highest risk of malignancy in the sinonasal tract (SIR 75.64; 95% CI, 53.53 to 103.83; AER 17.22), followed by bone, eye and orbit, oral cavity and pharynx, and lung and mediastinum.

Conclusion

Patients with history of sinonasal cancer are at significantly increased risk of developing an SPM. Careful monitoring for development of additional tumors may be warranted.

     

The role of social media in clubfoot: information sharing and social support

PurposeClubfoot is the most common congenital foot deformity in children. Caregivers often seek medical information on the internet. The aim of the study was to characterize how social media is used by caregivers to access medical information.MethodsA search was performed on Facebook, Twitter and YouTube platforms. Information was quantitatively assessed. Comments were qualitatively assessed, and the Kruskal-Wallis test was used to study thematic comment distribution.ResultsIn total, 58 Facebook groups and pages, 109 YouTube accounts and ten Twitter accounts related to clubfoot were discovered from 2007 to 2019. Facebook groups and pages had a collective 56 123 members and 80 544 total likes, respectively. YouTube had a collective 3 280 454 views, with 54 969 total comments throughout the accounts. Comment themes most commonly included sharing information and advice (38.7%), appreciation and success stories (12.8%), emotional support (12.7%) and social media as a second opinion (11.9%). Facebook groups contained a significantly higher number of comments related to ‘social media as a second opinion’ compared with Facebook pages (p = 0.001), Twitter (p = 0.016) and YouTube (p < 0.0001) while YouTube contained a significantly lower number of comments related to ‘sharing information’ compared with Facebook groups, pages and Twitter (p < 0.0001).ConclusionSocial media continues to be a growing tool for information sharing and the findings of this study highlight the importance placed by caregivers on the advice of their peers. The online presence of caregivers may represent an opportunity for orthopaedic surgeons to communicate with patients and help them make informed decisions.Level of evidenceIV     

Caregiver burden among poor caregivers of patients with cancer in an urban African setting

Objectives: The nature and magnitude of the problems facing caregivers remain largely unknown in developing countries of the world. This study addresses these issues in a group of caregivers of patients with cancer in Zaria, Nigeria. Method: One hundred and three patients attending an oncology outpatient clinic at the Ahmadu Bello University Teaching Hospital were enrolled in the study with their caregivers. The caregivers were interviewed using the Socio‐demographic data sheet, General Health Questionnaire‐30 (GHQ‐30) and Zarith Burden Interview (ZBI). A score of 4 or more in GHQ and scores above the median score of the sample in ZBI were considered a clinically significant level of psychological morbidity and a high level of burden, respectively. Data obtained were analyzed using the Statistical Package for Social Sciences Version 13 for Windows. All statistical tests of significance were carried out at 5% level of probability. Results: The patients were 60 women whose mean age was 57. Of the 103 caregivers, 60 (58%) were men and 43 (42%) were women. Their mean age was 37. Their mean ZBI and GHQ‐30 scores were 29.16±12.8 (median = 25) and 3.67±3.01, respectively. A high level of burden was found in 49.5% (95% CI 39.9–59.1%) and psychological morbidity was found in 46.6% (95% CI 37.0–56.2%) of the caregivers. High levels of burden and psychological morbidity were significantly associated with absence of financial support. Conclusion: The study demonstrated a high level of caregiver burden, psychological morbidity and financial strain in family caregivers coming to the clinic with a relative who has cancer in an urban Nigerian setting. Copyright © 2010 John Wiley & Sons, Ltd.     

Epidemiologic evidence linking oxidative stress and pulmonary function in healthy populations

Respiratory health in the general population declines regardless of the presence of pulmonary diseases. Oxidative stress has been implicated as one of the mechanisms involved in respiratory dysfunction. This review was to evaluate studies that relate oxidative stress factors with pulmonary function among the general population without prior respiratory illnesses. The search yielded 54 citations. Twenty-one studies qualified for incorporation in this review. Owing to the heterogeneity of the review, studies were discussed based on identified oxidative stress factors responsible for pulmonary dysfunction. Oxidative stress biomarkers, including gene polymorphisms of nuclear factor erythroid 2-related factor 2, heme oxygenase 1, glutathione S transferase, superoxide dismutase, and lipid peroxidation products were involved in lung function decline. In addition, the antioxidant status of individuals in reference to dietary antioxidant intake and exposure to environmental pollutants affected oxidative stress and pulmonary function, as indicated by forced expired volume in one second, forced vital capacity, and forced expiratory flow at 25%–75%_. This review indicated that oxidative stress is implicated in the gradual decline of lung function among the general population, and gene polymorphism along the antioxidant defense line and/or their interaction with air pollutants reduce lung function. Different polymorphic forms among individuals explain why the rate of lung function decline differs among people. Dietary antioxidants have respiratory health benefits in antioxidant gene polymorphic forms. Therefore, the genetic composition of an individual may be considered for monitoring and identifying people at risk of respiratory illnesses.     

Prevention of Oxidative Damage and Phytoremediation of Cr(VI) by Chromium(VI) Reducing Bacillus subtilus PAW3 in Cowpea Plants

Bulletin of Environmental Contamination and Toxicology - Experiments were conducted to observe the role of plant growth promoting (PGP) strain PAW3 in reduction of Cr(VI) and cowpea growth. PAW3...