Recent advances in the diagnostic evaluation of pancreatic cystic lesions

Pancreatic cystic lesions (PCLs) are becoming more prevalent due to more frequent abdominal imaging and the increasing age of the general population. It has become crucial to identify these PCLs and subsequently risk stratify them to guide management. Given the high morbidity associated with pancreatic surgery, only those PCLs at high risk for malignancy should undergo such treatment. However, current diagnostic testing is suboptimal at accurately diagnosing and risk stratifying PCLs. Therefore, research has focused on developing new techniques for differentiating mucinous from non-mucinous PCLs and identifying high risk lesions for malignancy. Cross sectional imaging radiomics can potentially improve the predictive accuracy of primary risk stratification of PCLs at the time of detection to guide invasive testing. While cyst fluid glucose has reemerged as a potential biomarker, cyst fluid molecular markers have improved accuracy for identifying specific types of PCLs. Endoscopic ultrasound guided approaches such as confocal laser endomicroscopy and through the needle microforceps biopsy have shown a good correlation with histopathological findings and are evolving techniques for identifying and risk stratifying PCLs. While most of these recent diagnostics are only practiced at selective tertiary care centers, they hold a promise that management of PCLs will only get better in the future.     

Variations in the prevalence of point (pre)hypertension in a Nigerian school-going adolescent population living in a semi-urban and an urban area

Background  

Hypertension has been shown to start in early life and to track into adulthood. Detecting adolescents with hypertension and prehypertension will aid early intervention and reduce morbidity and mortality from the disorders. This study reports the point-prevalence of the two disorders in a semi-urban and an urban population of school-going adolescents in Nigeria.     

Diseases mortality patterns in elderly patients: A Nigerian teaching hospital experience in Irrua,Nigeria

Background:

Currently, in developing countries, there is a paradigm shift in the mortality patterns from communicable to non-communicable diseases.

Objective:

This study is aimed at providing a broad spectrum on the mortality patterns in elderly within a 5-year-period in a tertiary healthcare provider in Nigeria.

Materials and Methods:

This study is a retrospective review of mortality patterns of elderly patients from January 2007 to December 2011 occurring in Irrua specialist teaching hospital, (ISTH), Irrua and its environs. Information derived from the request cards include age, sex, clinical history, diagnosis, duration and cause of death.

Results:

During this period a total of 3,002 elderly (>65 years) admissions were seen. Of this, 561 patients were confirmed dead. Among this, 317 and 244 cases were elderly male and female patients, respectively. Hence the ratio of male to female was 1.3:1.0. The peak age group was 65-70 years accounting for 147 patients (26.2%). The age range of patients was 65-104 years while the modal and mean ages were 69 years and 74 years ΁ 4.2 standard deviation (SD), respectively. The most commonly encountered cause of mortality was cerebrovascular accident constituting 141 (25.1%) cases. The 2^nd and 3^rd majority of mortality cases were malignancies and diabetes mellitus (metabolic disorder) accounting for 85 (15.2%) and 45 (8%) cases, respectively. Others include congestive cardiac failure 35 (6.2%), Septicaemia 29 (5.2%), trauma 26 (4.6%) while chronic renal failure and chronic obstructive pulmonary disease consist of 22 cases (3.9%) each.

Conclusion:

Non-communicable diseases particularly cerebrovascular diseases and malignancies were the most commonly encountered cause of elderly mortality in our environment. Notwithstanding a large percentage of mortality patterns also results from communicable diseases with sepsis as the leading cause of mortality.     

Pre-hospital management of diarrhoea among caregivers presenting at a tertiary health institution: implications for practice and health education

Background

Diarrhoeal diseases cause significant childhood morbidity and mortality worldwide. The effectiveness of home management of diarrhoeal diseases is achievable only if caregivers have appropriate information despite varying recommendations on the strategies for diarrhoea therapy.

Objectives

To evaluate caregivers'' perception and use of ORT fluids for management of diarrhoea in under-five age children in the face of varying phases of recommendations, as an indicator of home treatment.

Methods

Caregivers of U5 children presenting with acute watery diarrhoea to different Paediatrics clinics/wards of the University of Nigeria Teaching Hospital (U.N.T.H.), Enugu between October 2006 and February 2007 were interviewed with a structured questionnaire.

Result

Caregivers of 156 under-five children who met the inclusion criteria were recruited. Access to ORT fluids was high with 73.1% of all children with diarrhoea being offered an ORT fluid at home. However, the method of preparation and administration of fluids was quite unsatisfactory. Previous experience with ORT fluids, higher educational or socioeconomic status did not correlate significantly with better performance.

Conclusion

Despite high level of knowledge and acceptance of ORT among the study population actual practice was not satisfactory. Diverse practices by caregivers which represent the various phases of evolution in the types of fluids promoted for oral rehydration reflect some confusion that require urgent attention. Knowledge and skills of ORT need to be widely promoted on a continuing basis with the need for health workers to ensure that caregivers are taught and adhere to the correct recommendations on oral rehydration therapy.     

Experimental Trypanosoma brucei infection at immediate post partum period: effects on dam and the offspring

ObjectiveTo investigate the effects of immediate post-partum infection with Trypanosoma brucei (T. brucei) on dam and offspring.MethodsSixty female Albino rats (Rattus norvegicus) weighing between 130-170 g were used as animal model. The animals were divided as follows: 25 infected between 1-5 days post partum; 10 infected unbred as positive controls; and 25 uninfected as negative controls. The following parameters were evaluated: packed cell volume (PCV), level of parasitaemia, survival time, litter size and litter weight at birth and on days 7, 14 and 21 post delivery, using conventional methods. Possible trans-mammary transmission of infection to litter through milk was also assessed.ResultsThe results showed a comparatively (P< 0.05) higher mean PCV value for the uninfected negative control on the 8^th day post infection compared with the infected groups which corresponded with the increasing level of parasitaemia in the two infected groups. Mean litter size and litter weights were higher (P< 0.05) in the uninfected controls on the 21^st day. Survival time in the infected groups were similar. No evidence of trans-mammary transfer of infection was recorded. Conclusion: T. brucei infection during immediate post partum period is detrimental to the dam and impairs growth of the offspring.     

Skin diseases among children attending the out patient clinic of the University of Nigeria teaching hospital, Enug

Background

The prevalence of skin diseases varies worldwide and information regarding local prevalence of its various causes may help the development of policies towards better management.

Objective

To document the types of skin disorders seen among children attending the University of Nigeria Teaching Hospital, Enugu( UNTH).

Methods

The medical register from the children out patient clinic was used to obtain information on pattern and outcome of skin diseases seen from January 1996 to December 2005.

Results

Of the 16,337 children seen in children.s out patient clinic (CHOP), 1506 (1.3%) had a skin disease. Age range was one week to 16 years with a mean ± SD of 3.89 ± 3.8 years. Children aged 0 – 5 years constituted 70.24% of patients with skin diseases. The commonest skin condition was pyoderma (29.81%) seen mainly in those below 5 years, followed by scabies (13.55%). Approximately 1/3 (33.3%) of the patients were referred to the dermatology clinic.

Conclusion

Infectious skin diseases constitute a high percentage of skin disorders encountered in paediatrics. Almost half (48.4%) of the skin problems were diagnosed as non-specific dermatitis suggesting the need of better dermatological training of the paediatric residents.     

Correlation between maternal weight and insulin resistance in second half of pregnancy

Background:

In pregnancy, routine measurement of maternal weight gives a crude assessment of maternal and foetal well-being. Excess weight gain in pregnancy is related to increased risk for gestational diabetes mellitus (GDM), hypertension in pregnancy and foetal macrosomia. In the Nigerian context, lack of knowledge of pre-pregnancy weight coupled with late booking of women in pregnancy hinders accurate assessment of weight gain in pregnancy. The absolute maternal weight is often used as surrogate. This study evaluates the relationship between absolute weight in the second half of pregnancy and insulin resistance.

Patients and Methods:

The weight of hundred pregnant women was measured between 24 to 32 weeks of pregnancy and their insulin resistance was measured using Homeostatic Model Assessment (HOMA-IR) from fasting serum glucose and fasting serum insulin.

Results:

Twenty-six women had weight ≥95 kg and 74 women had weight of <95 kg. There was a significant positive correlation between weight and HOMA-IR (r = 0.248), fasting glucose (r = 0.198), and fasting insulin (r = 0.228), (P < 0.05). The mean weight, HOMA-IR, fasting glucose and fasting insulin were higher in women with weight ≥95 kg compared to those with less weight. Also maternal weight ≥ 95 kg was associated with severe insulin resistance, (Odds Ratio = 3.1).

Conclusion:

Absolute weight in pregnancy correlates well with insulin resistance. Women having weight ≥95 kg between 24-32 weeks of gestation were more likely to have severe insulin resistance with implications for increased risk of GDM and other complications.