The overall mortality and morbidity in underdeveloped countries are still unchanged and preventable risks factors constitute the main burden. Among these, anaesthesia-related mortality is largely preventable. Various contributory factors related to human resources, technical resources, education/teaching system and other utilities needs further attention in poor income group countries. Therefore, we have made an attempt to address all these issues in this educational article and have given special reference to those factors that might gain importance in (near) future. Proper understanding of anaesthesia-related resources, their overall impact on health care system and their improvisation methods should be thoroughly evaluated for providing safer anaesthesia care in these countries which would certainly direct better outcome and consequently influence mortality.

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Background Coronary artery disease (CAD) mostly occurs in persons older than 45 years of age. In India, CAD manifests almost a decade earlier than in Western countries. This study was done to study the risk factors and angiographic profile in young patients presenting with acute myocardial infarction (AMI). Patients and Methods: One hundred and twenty four consecutive patients presenting with AMI at less than 40 years of age were studied for risk factors. Coronary angiography was done in all. Results: Out of 124 patients, 123 were male. Mean age was 35.94 ± yrs. One hundred and eighteen had ST elevation myocardial infarction (MI) (95.16%) and six had non ST elevation MI (5.84%). Anterior wall MI was present in 88 patients (70.97%), inferior wall MI in 31 patients (25%) and lateral wall MI in five patients (4.03%). Seventy three patients (58.8%) were smoker, 55 were hypertensive (44.35%), 10 were diabetic (8.06%). Family history of CAD was present in 22 (17.7%) patients. Low High-density lipoprotein (HDL) was seen in 53 patients (42.7%), and high triglycerides in 60 patients (48.38%). Significant CAD was found in 88 (70.96%) patients, 13 (10.48%) had normal coronaries. Single vessel disease was seen in 57 patients, two-vessel disease in 15 patients and three-vessel disease in eight patients. Total 125 lesions were seen and left anterior descending (LAD) was the commonest vessel involved, with 78 lesions (62.4%). Conclusion: AMI in young almost exclusively occurs in male, and ST elevation MI is the main presentation. Anterior wall MI is most common, with LAD being involved in around 2/3 patients. Smoking, hypertension, low HDL and high triglycerides are the major risk factors.

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A couple, both carriers of the sickle cell anaemia trait (Genotype HbAS) with an offspring already affected with the genetic disease underwent a Pre-implantation Genetic Diagnosis/Polymerase Chain Reaction screening of biopsied blastomeres. DNA analysis of single blastomeres was carried out to find out indicated a viable intra-uterine pregnancy with embryos which carried the sickle cell mutation, which resulted in a livebirth (HbAS). PGD/PCR in combination with IVF appears to be the most suitable treatment plan for patients who are at a higher risk of reproducing offspring affected with inheritable genetic diseases.

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Background: Genital Chlamydia trachomatis infection is a common bacterial sexually transmitted infection worldwide. There is little information about this infection in Nigeria. This study determined the prevalence of genital Chlamydia trachomatis infection among female undergraduates of University of Port Harcourt and identify the various associated risk factors. Materials and Methods: A cross-sectional prospective study of 354 female students was done. Their socio-demographic characteristics and pattern of sexual behaviour was noted followed by collection of endocervical swab which was analysed with a Chlamydia Rapid Test Device. Data management was done by SPSS version 17.0 statistical package. Result: The prevalence of genital Chlamydia trachomatis infection was 30.2%. First coital exposure at14 years or less had the highest prevalence of the disease. Multiple sexual partners, tribe and inconsistent use of condom were significantly related with Chlamydia trachomatis infection. Conclusion: Genital Chlamydia trachomatis is prevalent among female undergraduates of the University of Port Harcourt.

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Background: Diabetes mellitus has been shown to cause severe impairment in exocrine pancreatic function and cyto-architecture. Ocimum grattissimum has been reported to lower blood glucose levels in experimental diabetic animals. This study, therefore, aims to investigate if treatment with O. grattissimum can alleviate these pancreatic complications of diabetes mellitus. The phytoconstituents and median lethal dose of the plant extract were determined. Materials and Methods: Eighteen rats were divided into three groups of six rats each. Diabetes mellitus was induced by single intraperitoneal injection of 65 mg/kg streptozotocin. Group 1 was the control and were given normal feed only; Group 2 was of diabetic untreated rats, while Group 3 was O. grattissimum-treated diabetic rats at a dose of 1,500 mg/kg. After 28 days, blood was collected by cardiac puncture of the anaesthetised animals and the serum was obtained for analysis of serum pancreatic amylase. Permanent preparations using routine biopsy method were employed for histological preparations. Results: Results showed that the level of pancreatic serum amylase in the test groups (diabetic and diabetic-treated) were significantly higher (P < 0.05) than the control group, while the diabetic-treated group was significantly lower than the diabetic group. Atrophic acinar tissue without β-cells was noted in the diabetic and diabetic-treated groups. Patchy areas of necrosis, oedematous interstitium, haemorrhagic and necrotic acinar cells were present in diabetic-treated groups. Conclusion: Direct association exists between the hyperglycaemic state caused by diabetes mellitus and the elevation of the serum pancreatic amylase and distortion of pancreatic cyto-achitecture. O. grattissimum-treatment reduced serum pancreatic amylase level to near normal and limit the extent of structural damage.

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Background: Intramuscular pethidine is one of most common opioids used for labour analgesia. There are a number of concerns in the literature regarding the use of pethidine. The aim of this study is to compare analgesic efficacy of paracetamol with pethidine for labour pain in normal vaginal delivery. Materials and Methods: In this single-blinded, randomised control trial, 80 primigravid singleton women with full-term pregnancy candidate for normal vaginal delivery, were entered the trial and divided in to pethidine (A) and paracetamol (B) groups. At the time of admission, age and body mass index of mother and gestational age based on last day of period were recorded. In both groups, intravenous promethazine and hyoscine were administered to each patient at the first stage of delivery. From beginning of active phase of delivery, patients in group A received 50 mg intramuscular pethidine injection. At the same time patients in group B, received an intravenous solution infusion containing 1000 mg paracetamol and 300 cc of normal saline. After child birth, average labour pain was assessed using Visual Analogue Scale (VAS) by direct questioning from patient in both groups. Results: After patients' selection, 19 individual omitted during study due to exclusion criteria and finally 30 patients in paracetamol group and 31 patients in pethidine group remained to enter the trial. There was no significant difference in age and BMI of mothers between both groups (P > 0.05). Maternal age and labour duration in paracetamol group had no meaningful difference with maternal age and labour duration of patients in pethidine group (P > 0.05). The average VAS pain score was significantly lower in paracetamol comparing to that of pethidine group (8.366 out of 10, 9.612 out of 10, respectively, P < 0.001). Conclusion: It is concluded that intravenous paracetamol is more effective than intramuscular pethidine to relief labour pain in normal vaginal delivery.

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Introduction: Obstructive sleep apnea (OSA) and Diabetes Mellitus (DM) are growing health challenges worldwide. However, the relation of OSA with type 2 diabetes is not well understood in developing countries. This study described the prevalence and predictors of OSA in type 2 DM patients using a screening questionnaire. Materials and Methods: Patients aged 40years and above with type 2 diabetes mellitus were recruited into the study consecutively from the outpatient clinics of a university hospital. They were all administered the Berlin questionnaire and the Epworth sleepiness scale (ESS) to assess the risk of OSA and the tendency to doze off, respectively. Anthropometric details like height, weight and body mass index (BMI) were measured and short-term glycaemic control was determined using fasting blood glucose. Results: A total of 117 patients with type 2 diabetes mellitus were recruited into the study. The mean (SD) age, height and BMI was 63 years (11), 160 cm (9) and 27.5 kg/ m² (5.7), respectively. Twenty-seven percent of the respondents had a high risk for OSA and 22% had excessive daytime sleepiness denoted by ESS score above 10. In addition, the regression model showed that for every 1 cm increase in neck circumference, there is a 56% independent increase in the likelihood of high risk of OSA after adjusting for age, sex, BMI, waist, hip circumferences and blood glucose. Conclusion: Our study shows a substantial proportion of patients with type 2 diabetes may have OSA, the key predictor being neck circumference after controlling for obesity.

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Background: Inhaled foreign bodies are common paediatric emergencies and a major cause of accidental deaths at home among Nigerian children especially among children below the age of 5 years. Different types of foreign bodies have been reported from the ordinary to the most bizarre. We evaluated the types of foreign bodies and sites of possible impaction of these foreign bodies along the tracheobronchial tree. Materials and Methods: A 6-year case record of 35 patients with foreign body inhalation was reviewed from January 2005 to December 2010 at the Otorhinolaryngology Department of Bayero University/Aminu Kano Teaching Hospital, Kano - North-western Nigeria. Basic information such as date of birth, age groups, gender, indication for bronchoscopy, type of foreign bodies, sites of foreign body impaction and surgical outcome were extracted and analysed. Results: Thirty-five patients [18 (51.4%) males and 17 (48.6%) females, aged 6 months-10 years] with a mean age of 5.1 years and median of 5 years (+/- 3.0 Standard Deviation). The most affected age group with 31.4% is 3-5 years. Groundnuts and whistles were the most frequently inhaled foreign bodies with an equal frequency of 25.7%, respectively. Foreign bodies were preferentially lodged in the left main bronchus in 8 (22.9%) patients compared to the right main bronchus in 6 (17.1%) patients. Conclusion: Public enlightenment both in the news/print media on the risk of foreign body aspiration especially among the under-five's is highly advocated. The left main bronchus may be a common site for impaction as well.

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Introduction: Particulate air pollution is associated with increased incidence of respiratory symptoms and decreased pulmonary, function but the relative impact of pollution from different domestic energy sources is not well-known or studied. Aim: The study was aimed at assessing the association between particulate concentrations, respiratory symptoms and lung function. Materials and Methods: It was a cross-sectional study comprised of randomly selected residents of three communities. These communities were selected according to the predominant type of fuel used for household cooking which were: firewood, kerosene and liquefied petroleum gas (LPG). Assessment of the indoor PM ₁₀ levels was done by filtration using the Gent stacked filter unit sampler for collection of atmospheric aerosol in two size fractions (PM _2.5 and PM ₁₀ ). The Medical Research Council (MRC) questionnaire was administered followed by spirometry test. Results: The mean PM ₁₀ concentration in participants using LPG, kerosene and firewood was 80.8 ± 9.52 μg/m ^[3] , 236.9 ± 26.5 μg/m ^[3] and 269 ±93.7 μg/m ^[3] , respectively. The mean age and height-adjusted percent predicted forced expiratory volumes in 1 s (FEV1) for men were 127 ± 7, 109 ± 40 and 91 ± 20 and for women were 129 ± 13, 115 ± 14, 100 ± 14 in users of LPG, kerosene and firewood, respectively. A similar trend was found in the forced vital capacity (FVCs). Users of firewood had significantly lower FEV1 and FVC compared with LPG users (P < 0.05). The participants using firewood had the highest prevalence of pulmonary and non-pulmonary symptoms (57.1%), whereas subjects using LPG had the lowest (23.8%). Conclusion: There are high levels of particulate matter pollutions with respiratory effects in residential indoor environments in Ile-Ife, Nigeria

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Background: This study assessed the seroprevalence of Helicobacter pylori antibodies among Iranian patients with human immunodeficiency virus (HIV) infection. It also examines whether anti H. pylori seroprevalence was associated with the severity of the HIV infection or the antiretroviral treatment. Material and Methods: A total of 114 HIV-infected patients and 114 age and sex-matched controls, without symptoms referable to upper gastrointestinal tract were recruited. Blood samples were obtained from all subjects. Serum IgG and IgA against H. pylori measured using the enzyme-linked immunosorbent assay (ELISA). Results: The rate of anti H. pylori IgG seropositivity was 57.9% in HIV-infected patients and 28.95% in controls (P < 0.001), while the rate of IgA seropositivity was 2.64% in HIV patients and 31.57% in controls (P < 0.001). Although there was an increasing trend of higher IgG and IgA titre by increasing CD4 cell count in HIV-positive patients, it was not reach statistical significance. There was no statistical difference in the serology of anti H. pylori IgG and IgA between patients receiving antiretroviral therapy comparing untreated HIV patients. Conclusions: This study showed higher seroprevalence of H. pylori IgG along with lower seroprevalence of H. pylori IgA in HIV-positive patients compared matched controls.

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Background: To examine the influence of maternal characteristics on timing of presentation for intervention following pre-labour rupture of membrane (PROM) at term. Materials and Methods: This was a descriptive study of cases of term PROM with singleton births at the University of Benin Teaching Hospital (UBTH) from October 2011 to December 2012. Interval from onset of PROM to presentation to hospital was used as dependent variable. From the study population, two groups were identified based on time interval (≤24 hours or >24 hours) from PROM to presentation to hospital and their relationship to socio-demographic characteristic examined. Results: Over the study period, records of 110 women met the inclusion criteria and were selected for analysis. Their mean age was 29.26 ΁ 0.67 years; they were all married with 41.8% being nulliparous women. The mean gestational age at presentation with PROM was 38.5 ΁ 1.2. Over 50% had tertiary level of education. Overall, 38.2% were in social class 1. With regard to maternal response behaviour to PROM, 65.5% presented to the hospital within 24 hours while 34.5% presented after 24 hours of rupture of membranes. Majority of those that presented within 24 hours of PROM were in (upper) social class 1 and 2 and this differed significantly from those that presented after 24 hours, most of whom were in (lower) social class 3,4 and 5; [56 (77.8%) vs 16 (22.2%) and 14 (36.8%) vs 24 (63.2%)] P = 0.0001. Conclusion: Delay in presentation after PROM, illustrative of maternal under utilisation of BPACR package, is associated with being in a lower social class. Socio-economic and educational empowerment of women is advocated, while prospective research on maternal perception and attitude towards ANC is proposed.

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Background: Human Parvovirus B19 (PVB19) is among the aetiology of aplastic crisis in human immunodeficiency virus (HIV)-infected patients. Several studies have indicated the importance of an infection agent in bringing about complications in immuno-compromised patients. The current study aims to determine the seroprevalence of IgM and IgG antibodies to PVB19 among HIV-positive patients and its association with clinical and epidemiological factors. Materials and Methods: In a case control study, 90 HIV-positive patients were compared with 90 sex and age matched healthy controls in terms of anti-PVB19 IgG and IgM along with other primary clinical and laboratory features. Results: The overall prevalence of positive anti-PVB19 IgG among HIV patients and controls were 81.1% and 28.9%, respectively (P < 0.001). None of the subjects showed positive results for anti-PVB19 IgM. Patients with CD4 ⁺ cell count <200 showed higher seroprevalence of positive anti-PVB19 IgG which did not reach statistically significant. However, anti-PVB19 IgG seropositivity differed significantly between HIV patients on different regimens of antiretroviral therapy (ART) (P < 0.05). Conclusion: Immunity against PVB19 is more prevalent among HIV-positive patients compared to healthy controls. However, positive HIV status is not associated with acute PVB19 infection. The presence of anti-PVB19 IgG does not necessarily protect the body from further complications like anaemia. Given the results of the study, AIDS patients are recommended to undergo screening for parvovirus antibody in order to prevent complications like aplastic anaemia.

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Background: Patients presenting with chest pain and evidence of functional ischemia by myocardial perfusion imaging (MPI), but lacking commensurate angiographic disease pose a diagnostic and therapeutic dilemma. They are often dismissed as having 'false-positive MPI'. Moreover, a majority of the available long-term outcome data for it has been derived from homogenous female populations. In this study, we sought to evaluate the long-term outcomes of this presentation in a multiethnic male-predominant cohort. Materials and Methods: We retrospectively identified 47 patients who presented to our institution between 2002 and 2005 with chest pain and evidence of ischemia on MPI, but with no significant angiographic disease on subsequent cardiac catheterization (cases). The occurrence of adverse cardiovascular outcomes (chest pain, congestive heart failure, acute myocardial infarction and stroke) post-index coronary angiogram was tracked. Similar data was collected for 37 patients who also presented with chest pain, but normal MPI over the same period (controls). Overall average follow-up was over 22 months. Results: Fifty-three percent (26/47) of the cases had one or more of the adverse outcomes as compared with 22% (8/37) of controls (P < 0.01). Of these, 13 (50.0%) and 3 (37.5%) were males, respectively. Conclusions: Ischemia on MPI is predictive of long-term adverse cardiovascular outcomes despite normal ('false-negative') coronary angiography. This appears to be gender-neutral.

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Background: There are several studies about the positive relation between physical inactivity or low cardio respiratory fitness with development of metabolic syndrome (MS). In contrast, physical activity had favourable effects on all components of MS but the quantity and the frequency of physical activity necessary to produce this beneficial effect has not been defined as yet. The aim of this survey was to study the association of regular physical activity, measured by patient's estimation of walking time per day, with MS. Materials and Methods: This cross-sectional study was conducted as a part of Isfahan Healthy Heart Program (IHHP). Persons who had no component of MS were considered as reference group. Demographic data were collected by questionnaire. Relation between walking time and MS was evaluated by using logistic regression adjusted by age, sex, socioeconomic status (SES), life style and food item. Results: The study populations consisted of 4151 persons. Lower physical activity was associated with higher prevalence of MS (P < 0.001). There was a negative relation between the usual daily walking time and MS. Adjusted odds ratio for age groups, sex, SES, life style and food items (fat and oil, sweet and sweet drink, rice and bread, fried food) revealed that MS decreases with increasing walking time (P < 0.05) [OR = 0.70 (0.52-0.94)]. Conclusion: Total daily walking time is negatively associated with MS and increasing daily walking time is an effective way for preventing MS.

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Background: Violence is a major public health issue, globally as well as in the African continent. This paper looks at Nigeria and begins the process of identifying the factors that predict interpersonal violence in that country. The purpose is to interpret the implications of the results presented here for violence prevention programmes in Nigeria. Materials and Methods : The study is based on the responses of 2324 Nigerians included in Round Four of the Afrobarometer surveys. The study concentrates on 579 respondents who reported either they or someone else in their family had been the victim of violence, defined as being physically attacked, in the past year. Results: A logistical regression analysis revealed five significant factors that predicted interpersonal violence: being the victim of a property crime, the fear of crime, the respondents faith, whethera police station was in the local area and poverty. The findings revealed that 43.7% of the sample had been victimised within the past year and 18.8% had been the victim of both violent and property crimes. One surprising findingwas the number of respondents who were re-victimised; 75% of violence victims also had been property crime victims. Conclusions: These findings suggest that target hardening should be the basis to plan, implement and evaluate violence prevention programmes in Nigeria. Prevention personnel and/or law enforcement need to respond to reported incidents of property and/or violence victimisation and attempt to prepare victims to protect both their premises and their persons in the future.

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Background: Myelo-meningoceles are part of congenital afflictions of the spinal column. They arise from the failure of the neural tube to fuse properly during early embryonic growth. The causes and sequalae are multiple and, therefore, require multiple disciplines, to handle them. This study assessed the role of inter-disciplinary approach in the management of myelo-meningoceles. Materials and Methods: From 1975 to 2007, the author repaired 20 midline lumbar and lumbo-sacral myelo-meningoceles; 5 in Jamaica and 15 in Nigeria. There were 11 males and 9 females. Their ages, at operation, ranged from 1 to 168 days. All had urine and faecal incontinence and severe paraparesis to paraplegia. Skeletal deformities were present in 16 cases. The operations were carried out under routine general anaesthesia and in prone position. All cases were followed-up for up to 60 months, apart from one who died 4 days at home after discharge. Results: There were no deaths within the period of hospitalisation, usually about 14 days. Those followed-up have not made much improvement, though they were able to sit up without support and move around by shifting on their buttocks on the floor. Conclusion: We must continue to help these patients, but under the umbrella of specialised rehabilitation centres with the different specialists working together to make these patients attain a meaningful life and be useful to themselves and the society.

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Background: Despite a high frequency of anaemia, a positive direct antiglobulin test (DAT) and bone marrow hyperplasia HIV-infected patients, lack of reticulocytosis may cause underdiagnosis autoimmune haemolytic anaemia (AIHA) in them. This study was carried out to determine the prevalence of autoimmune haemolytic anaemia in HIV-infected patients and to compare the haematological/immunological characteristics of subjects with anaemia and those without. Materials and Methods: A total of 350 HIV-infected subjects attending the Lagos University Teaching Hospital who consented were recruited for the study. This included 250 subjects with anaemia (haemoglobin concentration <10 g/dl) as cases and 100 subjects without anaemia as controls. Five milliliters of venous blood drawn from each subject was used for the full blood count, reticulocyte count and DAT. Results: Subjects with anaemia had lower mean CD4 cell count (284.3 cells/μl) and higher mean reticulocyte per cent (1.5%) than the non-anaemic subjects. The frequency of reticulocytosis was higher in female subjects than in males. Only 0.8% (2 of 250) of the study group screened positive to DAT, p = 0.0339. None of the subjects in control group screened positive to DAT. Conclusion: Autoimmune haemolytic anaemia is a rare complication of HIV infection in our geographical location.

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Vagino-vesico-cutaneous fistula is a rare condition characterised by continuous dribbling of urine and secondary infection of the involved areas with poor self-esteem. Osteomyelitis is delayed complication of radiotherapy treatment for cervical cancer. Treatment of these conditions is a challenging entity especially after previous surgery and irradiation. We present a case of vesicocutaneous - vesico vaginal fistula with osteomyelits of the right pubic bone which was a late complication of post-cervical cancer radiotherapy.

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