First clinical experiences with a new ovine Fab Echis ocellatus snake bite antivenom in Nigeria: randomized comparative trial with Institute Pasteur Serum (Ipser) Africa antivenom

During the past decade, effective snake antivenoms have become scarce in northern Nigeria. As a result, many patients severely envenomed by the saw-scaled or carpet viper (Echis ocellatus), which is responsible for more than 95% of the snake bites in the region, did not receive effective treatment and mortality and morbidity increased. To combat this crisis, a new monospecific ovine Fab antivenom (EchiTab) is being developed. Its theoretical advantages over conventional equine F(ab')2 antivenom are a more rapid tissue penetration and larger apparent volume of distribution (the volume of [tissue] fluid in which the the antivenom would be uniformly distributed to achieve the observed plasma concentration). In a preliminary study, two vials (20 ml; 1.0 g of protein) of EchiTab rapidly and permanently restored blood coagulability and cleared venom antigenemia in seven envenomed patients. Four experienced early reactions that responded to epinephrine. In a randomized comparative trial of one vial (10 ml; 0.5 g protein) of EchiTab or four ampules (40 ml; 2.12 g of protein) of Institute Pasteur Serum (Ipser) Africa polyspecific F(ab')2 antivenom, there were fewer reactions, but only 36% and 35% of patients, respectively, showed permanent restoration of coagulability, with the remainder requiring further doses. This suggests that 0.5 g (one vial) of EchiTab is approximately equivalent to 2.12 g (four ampules) of Ipser Africa antivenom, and that a higher initial dose will be required for most patients. Measurements of circulating venom and antivenom levels reflected the clinical events.

Skin cancer in African albinos

A review of 775 normally pigmented Africans and 18 African albinos with malignant skin tumours showed that squamous cell carcinoma was the most common tumour type, in contrast to Caucasians, in whom basal cell carcinoma is most frequent. In African albinos squamous cell carcinoma of the head and neck region was most frequent. However, the proportion of basal cell carcinomas was low also among albinos but higher than among normally pigmented patients. In contrast to the normally pigmented patients, there were no squamous cell carcinomas on the limbs in albino patients. We suggest that this difference was due to environmental factors, such as chronic leg ulcers, which might have been less influential in the albinos, who seldom lived more than 30 years. No cases of cutaneous melanoma or Kaposi sarcoma were found in the albino group.

Dispersal, disease and life-history evolution

Discrete-time susceptible-infective-susceptible (S-I-S) disease transmission models can exhibit bistability (alternative stable equilibria) over a wide range of parameter values. We illustrate the richness generated by such 'simple' non-linear systems in the study of two patch epidemic models with disease-enhanced or disease-suppressed dispersal. Dispersal between patches can have a profound impact on local patch disease dynamics. In fact, dispersal between patches may give rise to bistability in parameter regimes without bistability in single patch models.

Skin cancer in Zaria, Nigeria

Skin cancer from 775 patients in the savannah showed a preponderance of squamous cell carcinoma (SCC) of the leg related to neglected, poorly managed and chronic ulcers or scars from burns or injuries. SCC of the head and neck had no predisposing factor. Malignant melanoma overwhelmingly affected the feet, dermatofibrosarcoma affected the trunk and Kaposi sarcoma affected the limbs. Basal cell carcinoma (BCC) comprised only 2% of all skin cancers. The 18 albino patients had a higher frequency of both SCC and BCC mostly on the head and neck. Excisional surgery was generally effective, the wounds being closed primarily or by means of flaps and skin grafts. However, 98 patients required amputation below the knee for tibial involvement by SCC. The prognosis and health care costs of skin cancer will only be improved if burns and injuries are adequately treated.

Skin cancer of the head and neck in Zaria, Nigeria

This 12-year review looked at the clinical presentation and predisposing factors of head and neck cancer treated at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, from 1978 to 1989. There were 174 patients with skin cancer in the head and neck region out of a total of 721 skin cancer patients. Squamous cell carcinoma was the most common tumour type. Unlike in other sites where chronic ulcer and scars were the main predisposing factors, most of the head and neck skin cancers arose without any obvious underlying predisposing lesion. However, 14 of the 174 patients had albinism, a well-known risk factor for skin cancer in black Africans. The head and neck skin cancer patients usually presented late with advanced fungating lesions beyond curative surgery.

Farmers' choice of genotypes and trait preferences in tropically adapted chickens in five agro-ecological zones in Nigeria

This study aimed at determining chicken genotypes of choice and traits preference in chicken by smallholder farmers in Nigeria. Data were obtained from a total of 2063 farmers using structured questionnaires in five agro-ecological zones in Nigeria. Chi square (χ²) statistics was used to explore relationships between categorical variables. The mean ranks of the six genotypes and twelve traits of preference were compared using the non-parametric Kruskal-Wallis H (with Mann-Whitney U test for post hoc separation of mean ranks), Friedman, and Wilcoxon signed-rank (with Bonferroni's adjustments) tests. Categorical principal component analysis (CATPCA) was used to assign farmers into groups. Gender distribution of farmers was found to be statistically significant (χ² = 16.599; P ≤ 0.002) across the zones. With the exception of Shika Brown, preferences for chicken genotypes were significantly (P ≤ 0.01) influenced by agro-ecological zone. However, gender differentiated response was only significant (P ≤ 0.01) in Sasso chicken with more preference by male farmers. Overall, FUNAAB Alpha, Sasso, and Noiler chicken were ranked 1st, followed by Kuroiler (4th), Shika Brown (5th), and Fulani birds (6th), respectively. Within genotypes, within and across zones and gender, preferences for traits varied significantly (P ≤ 0.005 and P ≤ 0.01). Traits of preference for selection of chicken breeding stock tended towards body size, egg number, egg size, and meat taste. Spearman's rank order correlation coefficients of traits of preference were significant (P ≤ 0.01) and ranged from 0.22 to 0.90. The two PCs extracted, which explained 65.3% of the variability in the dataset, were able to assign the farmers into two groups based on preference for body size of cock and hen and the other ten traits combined. The present findings may guide the choice of appropriate chicken genotypes while the traits of economic importance may be incorporated into future genetic improvement and conservation programs in Nigeria.

Lack of effect of ivermectin on prepatent guinea-worm: a single-blind, placebo-controlled trial

The effect of ivermectin on prepatent guinea-worm was tested in a single-blind placebo-controlled trial; 400 adults were randomly allocated to a single dose of ivermectin (150 micrograms/kg) or placebo. Fifty-four of the 385 participants who were followed for 15 months developed a total of 69 emergent guinea-worms. There was no significant difference in the proportion of persons with emergent guinea-worms between the 2 treatment groups; 58% appeared in males. 80% of emergent guinea-worms were located below the knee. Migration of guinea-worms in the tissues was not affected. It is concluded that ivermectin has no effect on prepatent guinea-worms nor does it disturb their migration pattern. No adverse reaction to treatment was seen. It appears that ivermectin can be used safely as mass chemotherapy against onchocerciasis and lymphatic filariasis in areas where guinea-worm is also endemic.

Hemodialysis performance and outcomes among end stage renal disease patients from Sokoto, North-Western Nigeria

The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated.

Limb amputation in children in Zaria, Nigeria

Over a period of 10 years, a total of 118 limb amputations were performed in children at the Ahmadu Bello University Hospital, Zaria, Nigeria. The major indication for limb amputation was trauma and gangrene following post-fracture splintage by traditional healers. There was no case of peripheral vascular disease in these patients. None of the patients had a prosthesis applied. The very high number of limb amputations is certainly preventable by early and effective management of fractures.

Risk of hepatitis B virus in the slaughter house

The study involved 180 Nigerian butchers and 180 traders (controls) selected by multistage stratified sampling who had their sera assayed for HBsAg (hepatitis B surface antigen) by enzyme-linked immunosorbent assay method. The butchers and the controls had an HBsAg sero-prevalence rate of 9.4% and 3.3%, respectively. Various risky practices were more common among the butchers but their hepatitis B antigenaemia was not related to the duration of their occupational exposure. The study shows that the butchers constitute a high risk occupation for hepatitis B viral infection.

Catheter-free endoscopic laser ablation of the prostate using a 1-size prostatic stent

PURPOSE

Endoscopic laser ablation of the prostate is a safe alternative to transurethral prostatic resection. Recognized disadvantages include prolonged catheterization, postoperative discomfort and delayed symptomatic improvement. We assessed the role of a 1-size temporary prostatic stent in men undergoing endoscopic laser ablation of the prostate.

MATERIALS AND METHODS

A total of 55 men a mean of 73 years old with outflow obstruction, including 9 who presented in urinary retention, underwent endoscopic laser ablation of the prostate and temporary stenting. Urinary flow rate, residual urine volume, symptom score and prostate specific antigen were measured preoperatively, and 6 weeks (with the stent in situ), 3 months (after stent removal) and 12 months postoperatively. Duration of hospital stay and complications were also recorded.

RESULTS

Of the 55 men 37 (67%) voided immediately with the stent in situ, including 7 of the 9 in retention. At 6 weeks with the stent in place mean maximum urine flow was 17.3 ml. per second (preoperatively 8.7). Dysuria was reported by 3 patients. Stent related complications were rare. One stent migrated early, resulting in urinary retention, while 2 that migrated late were asymptomatic. No patient had acute urinary retention after stent removal. Maximum urinary flow rate measured at 6 weeks with the stent in situ was similar to that 1 year after endoscopic laser ablation of the prostate.

CONCLUSIONS

The use of a 1-size, inexpensive plastic prostatic stent enabled catheter-free endoscopic laser ablation of the prostate in 67% of our patients. Early improvements in the urinary flow rate and a lower incidence of dysuria were additional benefits. The result of endoscopic laser ablation of the prostate at 1 year was comparable to that of transurethral prostatic resection.

Smallholder cattle farmers' breeding practices and trait preferences in a tropical Guinea savanna agro-ecological zone

The present study was embarked upon to determine the breeding practices and choice of selection and breeding traits of cattle farmers in Nasarawa State and the Federal Capital Territory (FCT), Abuja, Nigeria. A total of 180 smallholder cattle herders were randomly sampled. However, analysis of data was restricted to 144 herders (81 from FCT and 63 from Nasarawa State). Primary data were collected through individual structured questionnaire administration. Chi-square (χ2) statistics were used to compare categorical variables. Arithmetic means of continuous variables between locations were tested using T test. Rank means were also calculated for within- and between-location comparisons of the preference traits. Chi-square automatic interaction detection (CHAID) algorithm was used to determine the influence of socio-economic parameters on the traits of preference. Access to credit, personal savings, and type of landholding were significantly (P < 0.05) different between the two locations with higher values recorded for farmers in FCT. However, farmers in Nasarawa State had significantly higher land expanse (2.28 ± 0.19 versus 1.29 ± 0.09). The production objectives were rated similar between locations. The number of foundation stock differed significantly between farmers in the two locations with higher mean recorded in Nasarawa (7.37 ± 0.37) compared to FCT (5.18 ± 0.19). However, mean herd size was higher (34.60 ± 2.58 versus 27.63 ± 2.00; P < 0.05) in FCT than Nasarawa. Among the productivity indices, only average age at first parturition and average calving interval were significantly (P < 0.05) influenced by location. Within the FCT, calving interval was the trait of utmost importance in selecting the breeding stock, followed by milk yield, disease resistance, and body size. In Nasarawa State, calving interval, disease resistance, milk yield, body size, and survival were ranked similarly (P  >0.05). Across the two locations, body conformation (P < 0.05) and calving interval (P < 0.01) were more highly rated in FCT than Nasarawa State, while heat tolerance was less rated (P < 0.05) in the former. All the traits of preference were influenced by socio-economic factors, and could be exploited in future breeding plans to boost cattle production. A new livestock census in the study area is also advocated to reflect the current reality as regards cattle distribution.

The effect of antibiotic- and hydrocortisone-containing ointments in preventing secondary infections in guinea worm disease

A randomized, single-blind, controlled study comparing the efficacy of an ointment containing two antibiotics, one containing one antibiotic plus hydrocortisone, and no treatment in reducing secondary infections in patients with patent Guinea worm was undertaken in the northern region of Ghana. Seventy-seven patients were included. Time to complete healing was significantly shorter in the treatment groups compared with the controls (P = 0.044 and P = 0.003, respectively). Secondary infections occurred more often in the controls (P = 0.00014). Ointments containing antibiotics are recommended for application at the early stage of patent Guinea worm infection.

Clinical audit and research in radiography practice: An exploration of the English landscape

BACKGROUND

Research and clinical audit are central to the quality improvement (QI) process in healthcare; whereas research produces new knowledge, clinical audit establishes if practice is meeting set standards. Thus, radiographers have responsibility to engaging in these QI activities. This study aimed to explore radiographers' understanding, attitudes and level of involvement in clinical research and audit across England.

METHODS

A cross-sectional survey using an online questionnaire for data collection over a 6-week period was employed. The questionnaire consisted of open and closed ended questions. Participants were recruited through social media. The quantitative data obtained was analysed using Statistical Package for Social Sciences (SPSS) Version 26 (IBM Inc, Armonk, NY) whilst content analysis was used to analyse the free-response data.

RESULTS

A total of 100 valid responses were obtained after exclusion of 45 partial and/or incomplete responses. Radiographers showed a positive attitude towards involvement in research and audit with overall mean score of 3.85 (SD 0.80) and 4.01 (SD 0.80), respectively. Of the respondents, 35.7% (n = 35/98) were currently involved in clinical audit projects whilst 78.6% (n = 77/98) have previously been involved. Radiographers with postgraduate degrees were significantly more likely to have initiated research, 61.5% (n = 16/26) (p = 0.01) and to have previously been involved with research, 80.8% (n = 21/26) (p = 0.02). A significant association between radiographers' role and implementation of changes, following an audit (p = 0.03) was noted. Similarly, a significant association was noted between radiographers' role and initiation of research (p = 0.05).

CONCLUSION

Clinical radiographers in England showed a positive attitude towards research and audit. However, this did not translate into actual participation in research and audit activities.

IMPLICATIONS FOR PRACTICE

The need to stimulate clinical radiographers' interest in clinical audit and research is highlighted. Additionally, the findings support the rationale for managers to give more support including protected time to radiographers to engage in QI activities.

Hemodialysis among pregnancy related acute kidney injury patients: A single center experience in North-Western Nigeria

Pregnancy related acute kidney injury (PRAKI) patients that underwent hemodialysis (HD) between May 2007 and April 2015 were studied with specific reference to clinical features, laboratory values, duration of pregnancy at the diagnosis of acute kidney injury and outcome. It involved 38 patients aged between 15 and 30 years. The main clinical features were fever, edema and oliguria. The leading etiological factors included ante/postpartum hemorrhage, septic abortion, and toxemia of pregnancy. The majority of cases occurred during the third trimester. PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. HD improved patient survival in our study.

Predicting heat stress index in Sasso hens using automatic linear modeling and artificial neural network

There is an increasing use of robust analytical algorithms in the prediction of heat stress. The present investigation therefore, was carried out to forecast heat stress index (HSI) in Sasso laying hens. One hundred and sixty seven records on the thermo-physiological parameters of the birds were utilized. They were reared on deep litter and battery cage systems. Data were collected when the birds were 42- and 52-week of age. The independent variables fitted were housing system, age of birds, rectal temperature (RT), pulse rate (PR), and respiratory rate (RR). The response variable was HSI. Data were analyzed using automatic linear modeling (ALM) and artificial neural network (ANN) procedures. The ALM model building method involved Forward Stepwise using the F Statistic criterion. As regards ANN, multilayer perceptron (MLP) with back-propagation network was used. The ANN network was trained with 90% of the data set while 10% were dedicated to testing for model validation. RR and PR were the two parameters of utmost importance in the prediction of HSI. However, the fractional importance of RR was higher than that of PR in both ALM (0.947 versus 0.053) and ANN (0.677 versus 0.274) models. The two models also predicted HSI effectively with high degree of accuracy [r = 0.980, R² = 0.961, adjusted R² = 0.961, and RMSE = 0.05168 (ALM); r = 0.983, R² = 0.966; adjusted R² = 0.966, and RMSE = 0.04806 (ANN)]. The present information may be exploited in the development of a heat stress chart based largely on RR. This may aid detection of thermal discomfort in a poultry house under tropical and subtropical conditions.

Absence of DNA and anti-leishmanial antibodies in dogs (Canis familiaris) in Plateau state, Nigeria

Dogs are important sentinels for the surveillance of some zoonotic diseases including human leishmaniasis. To obtain information on the role of dogs in the epidemiology of leishmaniasis in Nigeria, 98 sera and 204 DNA samples obtained from dogs were screened for anti-leishmania antibodies and DNA of Leishmania spp. using the enzyme linked immunosorbent assay (ELISA) and PCR, respectively. Initially, three out of the 98 sera samples had ELISA borderline optical density (OD) values and were retested. Two out of the three samples turned out to be negative while one sample gave yet a borderline OD value on a retest. A real time polymerase chain reaction (RT-PCR) targeting the 120-bp fragment of the minicircle kDNA of Leishmania spp. run on DNA extracted from EDTA preserved blood of the borderline positive serum failed to amplify the 120-bp sequence of Leishmania spp. In the second phase of the study, 204 DNA from dog blood samples were subjected to conventional PCR targeting the 300-350 bp of the internal transcribe spacer region 1 (ITS1) of Leishmania spp. None of the samples could be amplified (n = 204, 0%). Our study suggests that L. infantum is not prevalence in Jos, Plateau State, Nigeria and this should be confirmed using a larger sample of local dogs tested using PCR methods in lymphoid tissue samples.

Pitfalls in diagnosis of hepatitis B virus infection among adults Nigerians

OBJECTIVE

Hepatitis B virus infection is common in Nigerians and its diagnosis is necessary for effective treatment and eradication. This study is aimed at highlighting the serological factors jeopardizing the diagnosis and treatment of the infection among Nigerians adults.

PATIENTS AND METHODS

Three studies were carried out. The first study involved 56 Nigerian adults and it compared the assay of HBsAg by Haemagulation Method (HMA) with Enzyme linked immunoassay (ELISA). The second study was a comparison of Glaxo Welcome HB rapid test(GWHB) with ELISA in sero-assay of HBsAg and HBeAg among 25 Nigerian subjects while the third study was on the assay of the sera of HBsAg positive patients for HBeAg and anti-HBe in forty two Nigerian patients by ELISA.

RESULTS

The sero - prevalence rates of HBsAg were 41.8% and 61.8% by HM and ELISA respectively with false HBsAg sero-positives and sero-negatives by HM of 5.4% and 25.5% respectively. Similarly, there was sero-detection of HBsAg in 84% and 80% by ELISA and GWHB respectively in 25 Nigerian adults. In addition, 19% and 64% of the 42 patients with HBsAg sero-positivity were also positive for HBeAg and anti-HBe respectively, while 31% of the patients were both HBeAg and anti-HBe sero-negative.

CONCLUSION

Sero-diagnosis of HBsAg and other serological markers of infectivity in patients with HBV should be carried out by ELISA rather than HMA among adult Nigerians. Furthermore, high infectivity of the virus abounds among Nigerian with HBV infection.