Gait abnormalities in older adults with transthyretin cardiac amyloidosis

BACKGROUND

Transthyretin cardiac amyloidosis (ATTR cardiac amyloidosis) is caused by variant (ATTRv) or wild type (ATTRwt) transthyretin. While gait abnormalities have been studied in younger patients with ATTRv amyloidosis, research on gait in older adults with ATTR cardiac amyloidosis is lacking. Given ATTR cardiac amyloidosis' association with neuropathy and orthopedic manifestations, we explore the gait in this population.

METHODS

Twenty-eight older male ATTR cardiac amyloidosis patients and 11 healthy older male controls walked overground with and without a dual cognitive task. Gait parameters: stride width, length, velocity and stance time percentage were measured using an instrumented mat. ATTR amyloidosis patients were further categorized based on clinical and functional assessments.

RESULTS

We found significant gait differences between ATTR cardiac amyloidosis patients and healthy controls; patients had more variable, slower, narrower and shorter strides, with their feet spending more time in contact with the ground as opposed to in swing. However, the observed gait differences did not correlate with clinical and functional measures of ATTR cardiac amyloidosis severity.

CONCLUSIONS

Our results suggest that gait analysis could be a complementary tool for characterizing ATTR cardiac amyloidosis patients and may inform clinical care as it relates to falls, management of anticoagulation, and functional independence.

Influence of preoperative and intraoperative factors on recovery after aortic root surgery

OBJECTIVE

To determine the influence of intraoperative factors relative to preoperative risk factors on recovery after aortic root replacement (ARR).

METHODS

Retrospective review of baseline and intraoperative characteristics was performed of 822 patients at our Aortic Center from 2005 to 2019. Inclusion criteria were all patients age 18 and older who underwent ARR at our institution from 2005 to 2019. The primary endpoint was the aggregate outcome of "failure to achieve uneventful recovery (FUR)," as previously defined.

RESULTS

In total, 207 (25%) patients experienced FUR. The following preoperative and intraoperative variables were significantly associated with FUR in the multivariable analysis: cardiopulmonary bypass time (OR 1.01, 95% CI 1.01-1.02) open chest management (OR 5.67, 95% CI 2.65-12.1), ejection fraction (OR 1.03, 95% CI 1.01-1.04), chronic kidney disease > stage 3a (OR 2.37, 95% CI 1.54-3.63), bicuspid aortic valve (OR 1.54, 95% CI 1.21-1.96), and female sex (OR 1.30, 95% CI 1.06-1.61). Cardiopulmonary bypass time and open chest management were among the top three partial R2 contributors to the logistic regression model variance.

CONCLUSIONS

These findings suggest efficacy in using intraoperative parameters to predict postoperative outcomes after ARR.

Quantifying the effects of circulatory arrest on acute kidney injury in aortic surgery

OBJECTIVES

We aim to investigate the association between parameters surrounding circulatory arrest and postoperative acute kidney injury in aortic surgery.

METHODS

This is a single-center retrospective study of 1118 adult patients who underwent aortic repair with median sternotomy between January 2010 and May 2019. Acute kidney injury was defined on the basis of a modified version of the 2012 Kidney Disease Improving Global Outcomes Scale that excluded urine output. The primary outcome of interest was any stage of acute kidney injury.

RESULTS

Circulatory arrest was required in 369 patients, and 307 patients (27.5%) developed acute kidney injury: stage 1 in 241 patients, stage 2 in 38 patients, and stage 3 in 28 patients. Lower-body ischemia (the period during circulatory arrest without blood flow to kidneys) duration was not associated with acute kidney injury after multivariable logistic regression (1-40 minutes, odds ratio, 0.67; 95% confidence interval, 0.43-1.04; P = .075; >40 minutes, odds ratio, 0.67; 95% confidence interval, 0.29-1.55; P = .356). Hypertension (odds ratio, 1.65; 95% confidence interval, 1.09-2.54; P = .020), preoperative estimated glomerular filtration rate (odds ratio, 0.99; 95% confidence interval, 0.98-1.00; P = .010), packed red blood cell transfusion volume (odds ratio, 1.00; 95% confidence interval, 1.00-1.00; P = .028), and nadir temperature (odds ratio, 0.93; 95% confidence interval, 0.88-0.99; P = .013) were independently associated with acute kidney injury after multivariable analysis. Although there was a positive association between lower-body ischemia duration and development of acute kidney injury with univariable cubic spline, the positive curve was flattened after adjustment for the described variables.

CONCLUSIONS

Within the range of our clinical practice, prolonged lower-body ischemia duration was not independently associated with postoperative acute kidney injury, whereas nadir temperature was.

Utilizing mobile robotics for pelvic perturbations to improve balance and cognitive performance in older adults: a randomized controlled trial

Late-life balance disorders remain a severe problem with fatal consequences. Perturbation-based balance training (PBT), a form of rehabilitation that intentionally introduces small, unpredictable disruptions to an individual's gait cycle, can improve balance. The Tethered Pelvic Assist Device (TPAD) is a cable-driven robotic trainer that applies perturbations to the user's pelvis during treadmill walking. Earlier work showcased improved gait stability and the first evidence of increased cognition acutely. The mobile Tethered Pelvic Assist Device (mTPAD), a portable version of the TPAD, applies perturbations to a pelvic belt via a posterior walker during overground gait, as opposed to treadmill walking. Forty healthy older adults were randomly assigned to a control group (CG, n = 20) without mTPAD PBT or an experimental group (EG, n = 20) with mTPAD PBT for a two-day study. Day 1 consisted of baseline anthropometrics, vitals, and functional and cognitive measurements. Day 2 consisted of training with the mTPAD and post-interventional cognitive and functional measurements. Results revealed that the EG significantly outperformed the CG in several cognitive (SDMT-C and TMT-B) and functional (BBS and 4-Stage Balance: one-foot stand) measurements while showcasing increased confidence in mobility based on FES-I. To our knowledge, our study is the first randomized, large group (n = 40) clinical study exploring new mobile perturbation-based robotic gait training technology.

Utilizing Mobile Robotics for Pelvic Perturbations to Improve Balance and Cognitive Performance in Older Adults: A Randomized Controlled Trial

Late-life balance disorders remain a severe problem with fatal consequences. Perturbation-based balance training (PBT), a form of rehabilitation that intentionally introduces small, unpredictable disruptions to an individual's gait cycle, can improve balance. The Tethered Pelvic Assist Device (TPAD) is a cable-driven robotic trainer that applies perturbations to the user's pelvis during treadmill walking. Earlier work showcased improved gait stability and the first evidence of increased cognition acutely. The mobile Tethered Pelvic Assist Device (mTPAD), a portable version of the TPAD, applies perturbations to a pelvic belt via a posterior walker during overground gait, as opposed to treadmill walking. Forty healthy older adults were randomly assigned to a control group (CG, n = 20) without mTPAD PBT or an experimental group (EG, n = 20) with mTPAD PBT for a two-day study. Day 1 consisted of baseline anthropometrics, vitals, and functional and cognitive measurements. Day 2 consisted of training with the mTPAD and post-interventional cognitive and functional measurements. Results revealed that the EG significantly outperformed the CG in cognitive and functional tasks while showcasing increased confidence in mobility. Gait analysis demonstrated that the mTPAD PBT significantly improved mediolateral stability during lateral perturbations. To our knowledge, our study is the first randomized, large group (n = 40) clinical study exploring new mobile perturbation-based robotic gait training technology.

KNOWLEDGE OF EMERGENCY CONTRACEPTION AND PREDICTORS OF ITS USE AMONG FEMALE UNDERGRADUATES IN TWO NIGERIAN UNIVERSITIES

Background

Unintended pregnancies contribute to the high burden of unsafe abortion, maternal deaths and morbidities among undergraduates.

Objective

To assess the determinants of good knowledge and evaluate the trends in the practice of Emergency Contraception (EC) among female undergraduates.

Methods

This was a cross sectional study involving four hundred and twenty female undergraduates from two universities in Ibadan, Nigeria. Participants were recruited from their hostels and classrooms. Data collection was done using self-administered questionnaires and good knowledge was defined as three correct answers to five questions testing knowledge. The questionnaires also addressed their practices of EC. The data was stored on the computer, cleaned and analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Statistical significance was set at p <0.05.

Results

Two hundred and fourteen (51.0%) participants were aware of EC and the common sources were friends (43.4%), media (42.9%) and pharmacies (42.0%). One hundred and sixty-four participants (39.1%) had good knowledge of EC. Participants in the age group 20-24 years, second year of study, those who were aware of EC and had ever used EC were associated with good knowledge. Less than half (48%) of the sexually active participants used EC in the past six months and Levonogestrel (51%) was the commonest EC used. Menstrual irregularity and abdominal pain were the major side effects of EC.

Conclusion

The practice of EC is poor and with poor knowledge demonstrated among female undergraduates. There is therefore the need to improve information and access to EC in the university community.

An interprofessional model of care for oral health during pregnancy

The study aim was to appraise the relevance and appropriateness of an interprofessional prenatal oral care model among pregnant women and healthcare providers in British Columbia (BC), Canada. Audio-recorded semi-structured interviews with 39 purposefully selected participants (13 pregnant women and 26 healthcare professionals) were used qualitatively to appraise relevance of an existing model. The existing model emphasizes communication and collaboration among multiple health providers for the delivery of integrated prenatal oral care. All interviews were transcribed verbatim and analyzed using an inductive thematic approach and N-Vivo® software. During the first round of interviews, most participants considered the existing model as simple and well-defined but not fully relevant to the BC context. The participants suggested revisions to Steven's model to incorporate facilitators of integrated care, including interprofessional education, oral health funding, and advocacy for oral healthcare. Participants suggested a different graphical portrayal for the revised model; an implementation guide was also suggested. A revised model based on participants' feedback, was shared with 14 of the initial participants during secondary interviews. Further evaluation of the appropriateness of the revised model is warranted.

COVID-19 PANDEMIC: IMPACT ON GYNAECOLOGICAL ENDOSCOPY AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN

The impact of the COVID-19 pandemic on endoscopic services in a low resource economy is formidable. With the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there has been genuine concerns about the risk of transmission during gynaecological endoscopy via the diffusion of contaminated aerosols generated from CO2 leakage and smoke created by energy devices. A pragmatic step in mitigating transmission at the University College Hospital, Ibadan, resulted in the closure of the Endoscopic unit for 3 months whilst deploying increased hygienic methods coupled with social distancing. This however had its unintended consequences of delay and increased backlog of cases aside the economic losses. Developing a unit-based policy/protocol in response to any future unforeseen occurrence should take front stage in the planning and administration of the unit. Adopting global best practices and guidelines from researched evidence is not only imperative but desirable especially in the context of limited resources.

Pregnant women's perspectives on integrating preventive oral health in prenatal care

BACKGROUND

Oral diseases are considered a silent epidemic including among pregnant women. Given the prevalence of oral conditions among pregnant women and the reported association with adverse pregnancy outcomes, there have been suggestions for the inclusion of preventive oral care in routine prenatal care. However, due to the different administrative and funding structure for oral health and prenatal care in Canada, progress towards this integration has been slow. Our study sought to qualitatively explore the views of pregnant women in British Columbia (BC) on the strategies for integrating preventive oral health care into prenatal care services.

METHODS

A qualitative approach was utilized involving semi-structured interviews with fourteen (14) purposefully selected pregnant women in Vancouver and Surrey, BC. The interviews were audio-recorded and transcribed. The transcripts were analyzed using an inductive thematic approach. Study validity was ensured via memoing, field-notes, and member checking.

RESULTS

Interviews ranged from 28 to 65 min producing over 140 pages of transcripts. Analysis resulted in three major themes: oral health experiences during pregnancy, perspectives on integration and integrated prenatal oral care, and strategies for addressing prenatal oral health care. A majority of participants were supportive of integrating preventive oral care in routine prenatal services, with referrals identified as a critical strategy. Oral health education was recognized as important before, during, and after pregnancy; oral health assessments should therefore be included in the prenatal care checklist. Limited funding was acknowledged as a barrier to oral health care access, which may explain why few participants visited their dentists during pregnancy. Interprofessional education surfaced as a bridge to provide prenatal oral health education.

CONCLUSION

Pregnant women interviewed in this study support the inclusion of educational and preventive oral care during prenatal care, although their views differed on how such inclusion can be achieved in BC. They advocated the establishment of a referral system as an acceptable strategy for providing integrated prenatal oral health care.

A Qualitative Study of Health Care Providers' Views on Integrating Oral Health into Prenatal Care

OBJECTIVE

Providing preventive oral health during prenatal care is a recognized strategy for improving pregnant women's access to oral health care. This study sought to qualitatively explore the views of health care providers in British Columbia (BC), Canada, on strategies for integrating preventive oral health into prenatal care.

METHODS

Twenty-four purposefully selected health care providers (13 oral health and 11 prenatal care providers) in Vancouver and Surrey BC participated in audio-recorded semistructured interviews. Interviews lasted from 31 to 61 min, were transcribed verbatim, and were analyzed using an inductive thematic analysis with N-Vivo software. Study validity was ensured via memoing, fieldnotes, member checking, and external audit.

RESULTS

Thematic analysis revealed 5 major themes: perception of integrated care, relevance of integrated prenatal oral health, strategies for achieving integrated prenatal oral health, drivers of the integration process, and barriers to integrating oral health during pregnancy. Interprofessional collaboration based on information sharing and communication was identified as a critical factor for integrated care. Oral health checks should be a component of prenatal assessments for achieving integrated prenatal oral health. Participants recommended that prenatal providers should offer oral health education and use screening questions to identify the pregnant woman's oral health needs. The establishment of referral systems was advocated, while dental assessments and oral prophylaxis via the medical services plan were proposed. The inclusion of dental providers in prenatal teams and educating health care providers on interprofessional collaboration were also supported.

CONCLUSION

Oral health and prenatal providers in BC are positively disposed to adopting integrated preventive prenatal oral health care based on interprofessional collaborative practices. The inclusion of oral health providers in prenatal teams was suggested.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by policymakers for advocacy and decision making when planning care delivery programs for women during pregnancy. Including the suggested strategies could lead to increased access to, and utilization of, oral health services among pregnant women.

Febrile Convulsion among Hospitalized Children Aged Six Months to Five Years and Its Association With Haemoglobin Electrophoretic Pattern

Background

Febrile convulsion and sickle cell disease are common in tropical countries and both are associated with significant morbidity and mortality. Worldwide, Nigeria has the highest prevalence of sickle cell disease. However, there is a dearth of knowledge on the haemoglobin electrophoresis in patients with febrile convulsions.

Methods

This was a hospital based, descriptive, cross-sectional study of the relationship between haemoglobin genotype and febrile convulsion at the University of Ilorin Teaching Hospital over a period of 12 months. A self-designed pretested questionnaire was administered on the subjects, and necessary examinations and investigations were conducted.

Results

Of a total of 1675 children admitted into the emergency paediatric unit during the study period, children aged 6 months–5 years that presented with febrile convulsions were 167(10%). Of this, 1,212 were aged 6 months–5 years. Thus, the age specific, hospital-based prevalence was 13.8%. The M:F was 1.1:1. Their Haemoglobin genotype distribution was AA 131(78.4%), AS 23(13.8%), AC 6(3.6%), SS 6(3.6%), and 1(0.6%) SC. The mean age of the sickle cell disease patients was higher at 46.0±13.5 months compared to 29.2±15.4 months in the non-sickle cell disease patients (p=0.005). The mean packed cell volume in subjects with sickle cell anaemia was 8.8±1.5%; the only case of haemoglobin SC had packed cell volume of 20%, while the non-sickle cell disease patients had a normal PCV. Malaria was present in 80.4% of them.

Conclusion

Febrile convulsion remains a common cause of hospitalisation. It is uncommon in haemoglobin SS where severe anaemia is always an accompanying derangement. The packed cell volume is nearly normal in children with normal haemoglobin genotype.

Need for and relevance of prostate cancer screening in Nigeria

Prostate cancer (PCa) has become the most prevalent cancer among males in Nigeria, and similar to other black populations, Nigerian men present with more advanced disease at an earlier age than in several other ethnic groups. In this unscreened, high-risk group, the reference range for early detection and diagnosis as well as risk factors need to be determined through large-scale screening. Over 4 years, 1124 previously unscreened men between 40 and 85 years of age were screened at free community health programmes for PCa, using the common parameters of prostate-specific antigen (PSA) plus digital rectal examination (DRE). We thereby assessed the practicality and importance of screening. Consent was obtained, demographic data obtained, PSA measured using qualitative laboratory kits, and DRE performed by surgeons. We found that the number of men attending and consenting to screening increases from year to year. Of 40-85-year-old men, 85.4% consented, of whom 33.3% (a third) and 60% were 51-60 years old and 51-65 years, respectively. While 11.5% of men had PSA >4 ng/ml, 31.45% showed abnormal DRE. Of the men who took the PSA test, 79.2% also consented to the DRE, of whom 5.8% had combined abnormal DRE and PSA >4 ng/ml. Our findings suggest that Nigerian men are a willing group for screening by both the PSA and DRE with the positive response to calls for health screening and interest in prostate health. The finding of PSA >4 ng/ml in 11.15% of this population reveals the need for greater awareness and measures to increase early detection. However, the value and validity of established PSA reference ranges and cutoff of 'normal' still need to be established. Screening is very important to better define the PCa prevalence and characteristics in our population; otherwise political and economic circumstances will ensure that men still present late with aggressive PCa.

HybridICE® filter: ice separation in freeze desalination of mine waste waters

Freeze desalination is an alternative method for the treatment of mine waste waters. HybridICE(®) technology is a freeze desalination process which generates ice slurry in surface scraper heat exchangers that use R404a as the primary refrigerant. Ice separation from the slurry takes place in the HybridICE filter, a cylindrical unit with a centrally mounted filter element. Principally, the filter module achieves separation of the ice through buoyancy force in a continuous process. The HybridICE filter is a new and economical means of separating ice from the slurry and requires no washing of ice with water. The performance of the filter at a flow-rate of 25 L/min was evaluated over time and with varied evaporating temperature of the refrigerant. Behaviours of the ice fraction and residence time were also investigated. The objective was to find ways to improve the performance of the filter. Results showed that filter performance can be improved by controlling the refrigerant evaporating temperature and eliminating overflow.

Effect of sickle cell crises on glomerular filtration rate in children with sickle cell disease in Ilorin, Nigeria

Children with sickle cell disease (SCD) are plagued with incessant crises. There are few studies on the effect of sickle cell crises on renal function as determined by the glomerular filtration rate (GFR). This study was done to assess the effect of sickle cell crises on GFR during crises and after recovery into the steady state. GFR was assessed using the formula derived by Schwartz et al., for consecutive SCD patients aged between 3 and 18 years who came in crises and after recovery into the steady state. A total of 81 patients with a mean age of 9.95 ± 4.15 years in 81 episodes of crises met the inclusion criteria. Majority of the children (47) had vasooclusive crises, 19 had hyperhaemolytic crises, and 15 had features of both vasooclusive and hyperhaemolytic crises. The means value of GFR in ml/min/1.73 m(2) rose from 81.09 ± 22.92 to 116.24 ± 22.11 subsequent to recovery from vasooclusive crises into the steady state, from 77.45 ± 18.48 to 99.54 ± 17.71 following recovery from hyperhaemolytic crises into the steady state and from 90.95 ± 17.53 to 114.01 ± 22.44 following recovery from crises with features of both vasooclusive and hyperhaemolytic crises with corresponding significant P values of 0.000, 0.001, and 0.004 respectively. The reduced GFR observed during vasooclusive and hyperhaemolytic crises improved significantly following recovery into the steady state.

Bladder stone in a three-year-old Nigerian child with posterior urethral valve: a case report

BACKGROUND

Stone in the bladder is an uncommon presentation in the tropics, especially in children. Its rarity makes the index of suspicion to be low. Patients presenting with it may be mistaken for urinary tract infection (UTI) because of the presence of frequency and dysuria.

OBJECTIVE

To present a rare cause of urinary bladder stone in a child in the tropics.

METHODS

The patient, a three-year-old boy, presented with recurrent episodes of dysuria and stragury for a duration of about one year. Work up included clinical evaluation and laboratory assessments, results of which informed surgical intervention.

RESULTS

The child had been treated repeatedly for urinary tract infection. He was acutely ill with suprapubic tenderness dysuria and poor urinary stream. He was hypertensive. Micturating cystourethrography showed posterior urethral valves and a bladder stone. He had vesicolithotomy and valvotomy with improvement of his blood pressure.

CONCLUSION

The coexistence of bladder stone with PUV coupled with delayed diagnosis may be a predisposing factor to hypertension in children. Conventional surgical treatment gives good results.

Determinants of mortality of preterm babies in the university of Ilorin Teaching Hospital, Ilorin Nigeria

AIMS AND OBJECTIVES

A prospective study to identify the determinants of mortality among 185 preterm babies at the University of Ilorin Teaching Hospital, Ilorin.

SUBJECTS AND METHODS

Data on 185 preterm babies and their mothers were collected over a nine month period in a tertiary hospital to identify the determinants of mortality among these babies.

RESULTS

Factors identified as significant determinants of mortality were severe perinatal asphyxia (p = 0.000; OR = 71.31; 95% CI = 17.63-308.24), apnoea (p = 0.000; OR = 178.20; 95% CI = 20.64-7709.02), necrotizing entero-colitis (p = 0.001) and resuscitation duration (p = 0.003; OR = 5.33; 95% CI = 1.62-19.02).

CONCLUSION

The primary causes of death are severe perinatal asphyxia, respiratory distress syndrome and infection. In Nigeria, survival below 28 weeks gestation is less than 20%. The findings in this study highlight the need for prompt and effective resuscitation of these infants by a trained health worker with verifiable competence in newborn resuscitation. It also highlights the need for availability of functional facilities like ventilators and resources like surfactant.

Prevalence and determinants of pre-term deliveries in the University of Ilorin Teaching Hospital, Ilorin, Nigeria

In Nigeria, over 900,000 children under the age of five years die every year. Early neonatal death is responsible for a little over 20% of these deaths. Prematurity remains a significant cause of these early neonatal deaths. In some series, it is reported to be responsible for 60-70% of these deaths. This study aimed to determine the prevalence and determinants of pre-term deliveries at the University of Ilorin Teaching Hospital, Ilorin. This was a prospective cohort study conducted over a 9-month period at the University of Ilorin Teaching Hospital. Records of deliveries and data on maternal socio-biological and antenatal variables were collected during this period in order to determine the prevalence and determinants of pre-term deliveries. Out of the 2,489 deliveries that took place over a 9-month period, there were 293 pre-terms, giving a pre-term delivery rate of 120 per 1,000 deliveries. Of the total deliveries, 1,522 singleton deliveries that satisfied inclusion criteria were recruited; 185 of them were pre-term deliveries giving a case:control ratio of 1:7. Significant determinants of pre-term delivery identified were previous pre-term delivery (P=0.001; OR=3.55; 95% CI=1.71-7.30), antepartum hemorrhage (P=0.000; OR=8.95; 95%CI=4.06-19.78), premature rupture of the membranes (P=0.000; OR=6.48; 95%CI=4.33-9.67), maternal urinary tract infection (P=0.006; OR=5.89; 95%CI=1.16-27.57), pregnancy induced hypertension (P=0.007; OR=3.23; 95%CI=2.09-4.99), type of labor (P=0.000; OR=6.44; 95%CI=4.42-9.38) and booking status (P=0.000; OR=4.67; 95%CI=3.33-6.56). The prevalence of pre-term delivery was 120 per 1,000 live births. Factors significantly associated with pre-term delivery were low socio-economic class, previous pre-term delivery, antepartum hemorrhage, premature rupture of fetal membranes, urinary tract infection, pregnancy induced hypertension, induced labor, and booking elsewhere outside the teaching hospital.

Drug use among adolescents in Ilorin, Nigeria

The types and frequency of drug use among 1200 students aged 10-19 years was investigated and a prevalence rate of 40.1% found; currently used drugs included mild stimulants such as kolanut and coffee 294 (26.2%), alcohol 164 (14.5%), sniffing agents 80 (7.2%), amphetamine and ephedrine 66 (6.7%), cigarette 54 (4.8%), heroin 45 (4%) cocaine 40 (3.6%) and cannabis 38 (3.4%). Multiple drug use was found among the students, with the abuse of cannabis, cocaine and heroin being significant among those who smoked cigarette (P<0.001). The relative risk (RR) for cannabis use when cigarette was smoked was 37.4 (24.1-57.8); RR for cigarette smoking when alcohol was used, 6.8, while RR for cocaine abuse when cigarette was used, 21.8 (13.9-34.5) and 52.8 (29.2-95.5) when cannabis was used. It is therefore concluded that the use of the licit and "socially" acceptable drugs may pave the way for the abuse of illicit ones.

Sexual activity among adolescents in Ilorin, Kwara State, Nigeria

With the aid of a self-administered questionnaire, sexual activity was investigated among 1,200 students aged 10-19 years. Two hundred and sixty-four (23.7%) respondents indicated they were sexually active. The mean age at first intercourse was 11.3 years (SD=5.8 years), while the average number of sex partner was 2-3. Multiple sexual partners were found in 99 (69.2%) of the males and in 16 (32.7%) of the females (P < 0.05). Males were more sexually active, 189 (32.8%) compared with 73 (13.7%) females (P=0.000001; RR=2.4 (1.88-3.05). Two hundred and fifty-three (23.4%) ofthose respondents who claimed to be highly religious had sexual intercourse compared with 7 (50%) of those who claimed not to be religious (P=0.02; PR=0.47 (0.27-0.80). Those whose parents lived together were less likely to be sexually active. 184 (21.2%) versus 47 (34.8%) (P=0.005). It is therefore concluded that our adolescents especially males remain sexually active. It also demonstrates the dramatic lowering of age at first intercourse. Family supervision and level of religious activity were recognized as factors that have significant impact on sexual activity. Preventive efforts must therefore focus on these issues with the active involvement of the Pediatrician, parents and religious leaders.

Comparison of a needle-free high-pressure injection system with needle-tipped injection of intracavernosal alprostadil for erectile dysfunction

Patients identified from hospital records as using alprostadil injections for erectile dysfunction were invited to take part in this open crossover study. On alternate weeks eight patients were given intracavernosal needle injections and transdermal needle-free injection of alprostadil in a randomized order. Efficacy of injection and associated pain were assessed and compared for the two methods. Pain produced during injection was significantly greater with the needle-free system than with the needle-tipped injection whilst efficacy was significantly less. Bruising was reported in all except one patient following needle-free injection only. Patient ratings of the needle-free injector were significantly lower than ratings for needle-tipped alprostadil delivery and when asked to express a preference, every patient chose the needle-tipped injection over the needle-free device.

Correlates of emergency response interval and mortality from severe anaemia in childhood

A retrospective study to determine the influence of blood transfusion emergency response interval on Mortality from childhood severe anaemia was carried out. Admission records of all children with severe anaemia over a 5-year period was reviewed. Those who either died before transfusion or got discharged against medical advice were excluded. A total of 5790 patients were admitted during the 5 year period. Ten percent (10%) had severe anaemia. Malaria, the leading cause of anaemia in this series, was found in 80% of the patients. Twenty patients (3.3%) died before transfusion while 50 discharged from the hospital against medical advice. There was male preponderance. Ages 2-5 years were the peak age group for severe anaemia. No patient had haematocrit less than 5% but 20 (4.2%) had heaematocrit above 20%. The hospital stay for majority (74.8%) of the patients was 72 hours or less. Mortality (Case fatality) increases with increase in transfusion emergency response interval within 24 hours. Based on the transfusion emergency response interval versus mortality curve, a mortality risk assessment scores were derived for use in clinical practice to determine the risk of dying from the disease. We recommend that national or hospital policy on blood transfusion be enunciated to ensure that all patient with severe anaemia get transfused within 2 hours of diagnosis.

European Society for Impotence Research--third meeting. 30 January-2 February 2000, Barcelona, Spain

The role of sildenafil (Viagra; Pfizer Inc) in a variety of indications, including spinal cord injury following prostatectomy, was presented. Results obtained by comparing different therapies were also presented. The role of sildenafil in long-term users of intracavernous and intra-urethral therapy was presented by at least two groups with interesting results. Conversely, a presentation on the role of intracavernosal therapy in patients who had failed to respond to sildenafil revealed thought provoking-findings. The anticipation by delegates of an opportunity to preview new therapy was also satisfied, at least in part, with presentations on Invicorp (Senetek plc), sublingual apomorphine (TAP Pharmaceuticals Inc), BAY-38-9456 (Bayer Yakuhin Ltd), and a yohimbine/arginine combination. MUSE therapy (VIVUS Inc) was also revisited. The various presentations on the treatment of erectile dysfunction revealed a trend towards a more practical approach.

Packed red cell volume pattern in Nigerian preterm babies

Weekly packed red cell volume (PCV) was estimated in 57 Nigerian preterm babies whose gestational ages were less than 34 weeks. Babies were excluded if they required exchange blood transfusion or had major congenital malformations. The mean (SD) PCV at birth was 54.6% (8.3). The nadir of the PCV drop was at the 10th-11th week of life. The PCV at the nadir was 29.3% (SD 2.9). The rate of drop in the PCV was most rapid in the 1st 2 weeks (velocity -4.6% per week), but by the 7th week this had decreased to -1.2% per week. The findings indicate a slower rate of postnatal fall in PCV among Nigerian preterms. We recommend that PCV and systemic signs of anaemia be monitored for the 1st 12 weeks of life.

International Association for the Study of Pain--Ninth World congress. 22-27 August 1999, Vienna, Austria

At this meeting, novel analgesic effects were described for a number of compounds. Gabapentin was significantly effective in the treatment of pain associated with phantom limb pain after amputation and traumatic avulsion of the brachial plexus. Capsaicin analog, EC-665, prevented referred viscero-somatic hyperalgesia associated with bladder inflammation. Indomethacine was compared with UP-454-21, a selective COX-2 inhibitor showing comparable effectiveness between both drugs in their anti-inflammatory/analgesic properties. Contralateral treatment with local anesthetics resulted in a long-lasting anti-inflammatory effect in unilateral carra-geenan-induced inflammation. Spinal neostigmine reduced spinal bupivacaine-induced hypotension while lamo-trigine showed a definite benefit in varied patients with neuropathic pain. Intra-articular administration of a ketorolac and morphine combination following arthroscopic knee surgery showed a significant decrease in postoperative pain and the need for postoperative analgesic. Oral CR oxycodone was shown to be an effective analgesic for the oral management of postoperative pain.

American Urological Association--94th annual meeting. 1-6 May 1999, Dallas, USA

Traditional urological concerns, such as bladder instability, bladder cancer, prostate cancer and incontinence, were focused upon. In addition, significant attention was paid to erectile dysfunction, with varied developments in the field. Capsaicin was presented as having a role to play in the reduction of bladder instability, while a new formulation of oxybutinin was shown to improve female urge incontinence. The combination of topical estrogen and an oral agonist, phenylpropanolamine, also gave significant improvement in menopausal urinary urgency and incontinence. Tetrahydropyranyladriamycin (THPA) will possibly be effective for adequate prophylaxis against the recurrence of early bladder cancer. COX-2 receptor modulation has a role in the treatment of bladder cancer, whilst the endothelin receptor antagonist ABT-627 (Abbott International Ltd) may prove effective in the treatment of prostate cancer. Melanotan II (PNU-83757; Pharmacia and Upjohn Inc) and IC-351 (Icos Corp) are new compounds for the treatment of erectile dysfunction (ED), and more light is shed on a role for apomorphine for the same indication.

Prevalence of antibodies to parasitic infections in Nigerian children

Sixty-six sera from Nigerian children who attended a paediatric clinic at University College Hospital, Ibadan were tested with Plasmodium falciparum, P. brazilianum, Entamoeba histolytica, Toxoplasma gondii and Schistosoma mansoni antigens using indirect fluorescent antibody technique. These sera were tested using ELISA technique for Schistosoma antibodies. Sera from all proven cases of infections gave positive results. Highest antibody prevalence rate was for P. falciparum (69.6%), followed by P. malariae (63.6%) and E. histolytica (42.4%) infections. About 17% and 16% were reactive with Toxoplasma and Schistosoma antigens respectively. Only nine (13.6%) children were negative with all antigens. Forty-four (66.6%) children were positive to two or more parasitic antibodies indicating exposure to those diseases. The significance of these antibodies in children is discussed.

Studies on the immunopathology of the nephrotic syndrome associated with Plasmodium malariae. 1. Serum levels of an immune adherence inhibitor

A comparative study of the serum levels of an immune-adherence inhibiting factor was carried out on serum samples from eighty-seven nephrotic syndrome children, twenty-eight nephrotic adults, 202 normal school children, 116 blood donors, twenty-five falciparum malaria children and 172 patients with miscellaneous diseases. Low titres (1/32 and below) of the factor were present in sera from 63.2% of the nephrotic children 60.7% of nephrotic adults and 60.0% of children malaria, as compared with 30.7% of the normal children, 25.5% of the patients with miscellaneous diseases and 41.4% of the blood donors. There is a significant difference between nephrotic children and normal children with low titres (P less than 0.05). Furthermore, 36.8% of the nephrotic children had serum titres of 1/4 or less, as compared with 6.4% of normal children. The serum factor is tentatively referred to as 'C3b-inase'. Its similarity to conglutinogen-activating factor (KAF) and its possible role in the pathogenesis of the immune-complex nephropathy of childhood nephrotic syndrome associated with malaria are discussed.

Sarcoma botryoides in a Nigerian female infant

A case of sarcoma botryoides has been reported in a 10-month-old Nigerian female infant. The tumor has behaved true to form by its location and histologic appearance. The prognosis in this child is still guarded, as chemotherapy has been the only form of treatment. Although she has been under observation for one year now, there has been no local recurrence of the tumor.

Quartan malarial nephrotic syndrome in children

Quartan malarial infection causes an immune complex nephritis in some individuals, which, once established, is sustained by mechanisms not yet fully explained, but which probably involve autoimmune processes. The presenting clinical and biochemical findings of the quartan malarial nephrotic syndrome are similar to those classically described for the nephrotic syndrome in childhood, but the renal pathology seen on light, electron, and immunofluorescent microscopy show striking differences and distinctive features. The disease tends to pursue a chronic course and in most patients is nonresponsive to treatment with antimalarial drugs, prednisolone, and immunosuppresive drugs. The overall prognosis is poor, with most patients developing hypertension and evidence of renal failure within 3 to 5 years of onset.

A controlled trial of cyclophosphamide and azathioprine in Nigerian children with the nephrotic syndrome and poorly selective proteinuria

In a controlled trial, symptomatic treatment alone, or 12 weeks of cyclophosphamide or azathioprine were compared in Nigerian children with nephrotic syndrome (mainly quartan malarial nephropathy) and poorly selective proteinuria. Full remission in 2 patients in each of the two groups treated with drugs, and diminution of proteinuria in most patients in the cyclophosphamide group showed possible evidence of benefit. Infections during treatment were significantly more common in the drug-treated groups but were controllable. Mortality from renal failure in the 2nd year after treatment was significantly greater in the azathioprine-treated group than in the other two, suggesting that the drug may have exacerbated the nephritis. The 5-year survival rate was similar in the cyclophosphamide and the control group.

Fatal herpes zoster in Burkitt's lymphoma following contact with chicken pox

Burkitt's lymphoma presented atypically in a six-year-old Nigerian girl with back pain, oliguria and facial oedema following a fall at school. Two weeks later, she developed bilateral ptosis, hepatomegaly and ascites. Burkitt's lymphoma cells were found in both ascitic and cerebrospinal fluids. She was successfully treated with intravenous cyclophosphamide and intrathecal methotrexate but later developed fatal herpes zoster at the same time as the resident doctor developed chicken pox. Chart's review showed that she had been in brief contact with chicken pox during a short stay in a transit ward prior to full admission.

Plasma immunoglobulin levels in Nigerian infants in the first year of life

Serial estimations of plasma immunoglobulins IgG, IgM and IgA were undertaken in the first year of life of healthy Nigerian infants by the single radial immunodiffusion method. High levels of IgG present at birth dropped below half their values in the first month of life and remained low for about four months after which a sustained rise was observed although birth levels were not attained at 1 year of age. IgM was low at birth and IgA was absent but was detached at one month. Both IgM and IgA rose rapidly in the first four months of life which is in keeping with immunological competence and primary antibody response to various subclinical infections in infancy.

Differential protein clearances and response to treatment in Nigerian nephrotic children

Remission followed prednisolone therapy in 9 out of 21 Nigerian children with the nephrotic syndrome who had highly selective proteinuria (CG/CA less than 15%). Of these, 5 patients have remained well off all treatment during a follow-up of nearly 5 years, 4 have relapsed more than once but have responded to further courses of prednisolone. 3 of 21 with less selective proteinuria also remitted but all relapsed and only one of these has responded again. The other two have relapsed and further courses of prednisolone have not totally abolished their proteinuria though they are asymptomatic and in good health. Toxicity (hypertension, sometimes with encephalopathy and infection) was commoner in the patients with less selective proteinuria treated with steroids than in those with highly selective proteinuria. 3 steroid-sensitive patients who had had repeated relapses became free from relapse off all treatment after a course of cyclophosphamide, given during steroid-maintained remission. All but 2 of the renal biopsies taken were regarded as abnormal. The lesions were less severe in those who responded than in those who did not. There is some evidence to suggest that Plasmodium malariae may be a cause of some of the steroid-sensitive disease, as well as the steroid-resistant.

Rickets in Nigerian children--response to vitamin D

The findings in 20 cases of nutritional rickets treated on an out-patient basis with oral calciferol and calcium gluconate are reported. Attention was paid to their clinical, biochemical and radiological responses. If was noted that presentation at the hospital out-patient department was always delayed until there were obvious and sometimes severe deformities in the children. Biochemical changes noted during the early phase of treatment showed an initial fall in the level of serum calcium and plasma phosohorus and a rise in the serum alkaline phosphatase. About three months after initiating treatment, calcium and phosphorus reverted to normal levels but serum alkaline phosphatase still remained high. Twelve of our cases (60 per cent) suffered from protein calorie malnutrition of the marasmic type and showed an apparent resistance to vitamin D therapy in what may be regarded as normal dosages. Response was however, achieved with substantial increase in the amount of vitamin given. There was a striking sex difference in the ratio of 15 males to five females indicating that males are more likely to develop nutritional rickets than females when subjected to predisposing environmental conditions. Vitamin D resistant type of rickets was not encountered in this study.