Tertiary Hospital In South West Nigeria Research Articles

Pregnancy-related acute kidney injury: Etiologies and short-term outcomes in a tertiary hospital in Southwest Nigeria.

Although the incidence of pregnancy-related acute kidney injury (PRAKI) is declining in developing countries, it still remains a major cause of maternal and fetal morbidity and mortality. The aim of this study was to determine the etiologies, short-term outcomes, and their predictors in patients with PRAKI managed in a tertiary health facility in Southwest Nigeria over a four-year period. This was a four-year retrospective review of clinical records of patients managed for PRAKI in University of Medical Sciences Teaching Hospital, Ondo State, Nigeria. Thirty-two women with a mean age of 31.09 ± 7.50 years had PRAKI during the period reviewed. Twenty-four (75%) patients were multiparous and PRAKI was most common in the postpartum period (56.3%). Twenty-three patients (71.9%) were in RIFLE Stage 3, 24 (75%) received blood transfusion, 5 (15.6%) required intensive care unit (ICU) care, 24 (75%) needed dialysis while 19 (59.4%) had hemodialysis. The common causes of PRAKI were obstetric hemorrhage in 16 (50%), sepsis in seven (21.9%), and eclampsia in six (18.8%). Maternal and fetal mortality were 34.4% and 50% respectively. Seventeen (53.1%) had full renal recovery and only one (3.1%) became dialysis dependent. Significant factors that were associated with maternal mortality were admission to ICU (P = 0.01), hypotension (P = 0.02), and impaired consciousness (P <0.001) PRAKI is still relatively common and significantly contributes to maternal and perinatal mortality in Nigeria. Obstetric hemorrhage which is the most common cause of PRAKI is preventable and treatable. There is a need for physicians to effectively prevent and manage obstetric hemorrhage.

Awareness and Practice of Proper Health Seeking Behaviour and Determinant of Self-Medication among Physicians and Nurses in a Tertiary Hospital in Southwest Nigeria

Background: There is generally a lack of good health-seeking practices among health professionals due to a variety of factors, including the intensity of the medical practice itself. Doctors and nurses are perceived to have a good knowledge of ideal health-seeking behaviors and as such, it is important to determine the level of their awareness and estimate whether this knowledge is put into practice. This study, therefore, aimed to determine the level of awareness and practices of proper health-seeking behavior and to identify the factors responsible for self-medication among doctors and nurses in a tertiary hospital in Nigeria. Methodology: A cross-sectional descriptive study was conducted between April and may 2018 among 106 doctors and 164 nurses in a tertiary health facility in Ido-Ekiti, Ekiti State, Southwestern Nigeria. A simple random sampling technique by balloting was performed from the list of doctors and nurses in the hospital to select doctors and nurses that participated in the study. A pretested semi-structured self-administered questionnaire was designed and used to collect data. The data were entered into the computer software and analyzed using SPSS version 20. P ≤ 0.05 was taken as significant. Result: Out of 106 doctors and 164 nurses recruited, only 102 doctors and 143 nurses filled the questionnaire completely and returned for analysis. One hundred and four respondents (42.4%) fall within the ages of 31 - 40 years with a male to female ratio of 1:1.23. Awareness of proper health seeking behavior among both doctors and nurses was high among the two groups with no statistically significant difference between them. Twenty-nine (28.0%) doctors compared with thirty-four (23.8%) nurses go for a regular medical check-up with no statistically significant difference between the two groups (p = 0.411). Out of these, 5 (17.2%) doctors and 7 (23.8%) nurses visit at an interval of less than 6 month (p = 0.736). There is a statistically significant difference in the number of doctors (60.8%) compared with nurses (41.3%) that have consulted a doctor in the last one year (p = 0.003). More than half (51.6%) of this consultation among doctors was over the phone whereas 64.4% of such among nurses were via clinic appointment (p = 0.008). More doctors (90.2%) comply with their treatment prescription from physicians compared with nurses (77.6%) (p = 0.010). More nurses compared with doctors self-medicate when ill [Doctor 61.8% (63), Nurses 78.3% (112)] (p = 0.005) and had also self-medicated in the last one year [Doctor 34.3% (35), Nurses 42.7% (61)] (p = 0.187). Decreasing age, decreasing years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services are factors that significantly increased the likelihood of self-medication among doctors and nurses within the last one year. Conclusion: Awareness of proper health seeking behavior was high but this did not translate into proper health-seeking practices among doctors and nurses. There is apathy for regular medical check-up and self-medication was also high among this group of health workers. Decreasing age and years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services were factors were identified to significantly increase the likelihood of self-medication.

Chronic kidney disease in the emergency centre: A prospective observational study.

IntroductionLate presentation, usually to the emergency centre (EC), is frequently reported among patients with chronic kidney disease (CKD) in resource-limited settings, and is known to be associated with poor outcomes. This study aims to describe the pattern of EC presentation of adults with CKD in Southwest Nigeria.MethodsThis was a prospective observational study of 158 consecutively presenting CKD patients at the EC of two tertiary hospitals in Southwest Nigeria. Patients 18 years of age or older who were admitted into the EC at either study site with an admitting diagnosis of CKD and who consented to participate in the study were recruited. Socio-demographic characteristics, primary reason(s) for admission into the EC, requirement for dialysis, as well as the indication for dialysis were documented. The patients were followed-up for the duration of their stay in the EC and the outcome of EC admission documented.ResultsOverall, 54 (34.2%) were females, median age was 49 years and 74.1% were not known to have CKD prior to EC admission. The commonest indications for admission into the EC were uraemia, sepsis and hypertensive crisis, with 73.4% of the patients having at least one indication for dialysis at EC admission. The commonest indications for dialysis were uraemia, marked azotaemia and acute pulmonary oedema. The median time to first session of dialysis was 48 h and 24.1% of patients who required dialysis were not dialysed. Death during the period of EC admission occurred in 14 (8.9%) patients all of whom were not previously known to have CKD.DiscussionThere is a large pool of undiagnosed CKD among the general population. In many of these, the diagnosis will likely be made only when they present to the EC with complications. Late diagnosis is associated with worse outcomes.

Comparison of caecal intubation rates between morning and afternoon colonoscopies at a tertiary hospital in Southwest Nigeria

Background: Caecal intubation is an important measure of the quality of colonoscopy. Information on the effect of the time of colonoscopy on caecal intubation rate (CIR) is scarce. This study aimed to compare the CIR between morning and afternoon colonoscopies at the University College Hospital, Ibadan, Nigeria. Methods: A descriptive study of consenting patients referred for colonoscopy at the endoscopy unit of the University College Hospital, Ibadan, from January 2016 to March 2017. Bowel preparation consisted of liquid diet and Epsom salt. Pre-medications were intravenous Midazolam 2.5-5 mg and Pentazocine 15-30 mg in titrated doses. Colonoscopy was performed using Olympus Exera III Videocolonoscope (CF HQ190L, Olympus UK). Morning procedures were those carried out between 8.30 am and 12.00 noon, while those after 12.00 noon were classified as afternoon procedures. Caecal intubation was considered successful when the medial wall of the caecum was visualized. Results: Total of 177 colonoscopies were performed with 115 (65%) performed in the morning and 62 (35%) in the afternoon. In the morning, median age was 60 yrs, while in the afternoon, it was 61 yrs. Males (60.9% vs 58.1%) predominated in the morning, whereas females predominated in the afternoon (41.9% vs 39.1%), ( p =0.72). In the morning, 100 (87%) patients had good/satisfactory bowel preparation, but 52 (83.9%) patients in the afternoon.( p =0.57). CIR was higher in the morning (90.4%), compared to afternoon (88.7%) ( p =0.72). Conclusion: There was no statistically significant difference between CIR in the morning and afternoon procedures. Keywords: Caecal intubation rates, morning, afternoon, Southwest Nigeria

Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria

BackgroundCaesarean delivery carries a risk of major intra-operative blood loss and its performance is often delayed by non-availability of blood and blood products. Unnecessary cross-matching and reservation of blood lead to apparent scarcity in centres with limited supply. This study set out to identify the risk factors for blood transfusion in women who underwent caesarean delivery at a tertiary obstetric unit with a view to ensuring efficient blood utilization.MethodsA prospective cohort analysis of 906 women who had caesarean deliveries at the Lagos State University Teaching Hospital, Nigeria between January and December, 2011. A comparison was made between 188 women who underwent blood transfusion and 718 who did not. Data were obtained on a daily basis by investigators from patients, clinical notes and referral letters using structured pre-tested data collecting form. Socio-demographic characteristics; antenatal, perioperative and intraoperative details; blood loss; transfusion; and puerperal observations were recorded. EPI-Info statistical software version 3.5.3 was used for multivariable analysis to determine independent risk factors for blood transfusion.ResultsOf the 2134 deliveries during the study period, 906 (42.5%) had caesarean deliveries and of which 188 (20.8%) were transfused. The modal unit of blood transfused was 3 pints (41.3%). The most common indication for caesarean section was cephalo-pelvic disproportion (25.7%).The independent risk factors for blood transfusion at caesarean section were second stage Caesarean Section (aOR = 76.14, 95% CI = 1.25–4622.06, p = 0.04), placenta previa (aOR = 32.57, 95% CI = 2.22–476.26, p = 0.01), placental abruption (aOR = 25.35, 95% CI = 3.06–211.02, p < 0.001), pre-operative anaemia (aOR = 12.15, 95% = CI 4.02–36.71, p < 0.001), prolonged operation time (aOR = 10.72 95% CI = 1.37–36.02, p < 0.001), co-morbidities like previous uterine scar (aOR = 7.02, 95% CI = 1.37–36.02, p = 0.02) and hypertensive disorders in pregnancy (aOR = 5.19, 95% CI = 1.84–14.68, p < 0.001). Obesity reduced the risk for blood transfusion (aOR = 0.24, 95% CI = 0.09–0.61, p = 0.0024).ConclusionThe overall risk of blood transfusion in cesarean delivery is high. Paturients with the second stage Caesarean section, placenta previa, abruptio placentae and preoperative maternal anaemia have an increased risk of blood transfusion. Hence, adequate peri-operative preparations for blood transfusion are essential in these situations. Optimizing maternal hemoglobin concentration during antenatal period may reduce the incidence of caesarean-associated blood transfusion.

Gender Preference among Women Attending Antenatal Clinic in a Tertiary Hospital in Southwest Nigeria

Gender Preference among Women Attending Antenatal Clinic in a Tertiary Hospital in Southwest Nigeria

Antibiotic susceptibility of wound swab isolates in a tertiary hospital in Southwest Nigeria.

Background:Wounds are commonly encountered in the clinical practice. Microbacterial colonization and infection negatively affect wound outcomes. With increasing emergence of antibiotic-resistant strains, it is essential to determine local patterns of wound microbiological profile and antibiotic susceptibility to guide rational empirical antibiotic use.Materials and Methods:Consecutive patients who presented to the plastic surgery unit were recruited to the study over a 6-month period. Wound swab cultures were performed at presentation using standard protocols and media. The wound swab was performed by the Levine technique and data were analyzed using a statistical software package.Results:Eighty-five microbial isolates were obtained from the eighty patients (55 males and 25 females) recruited. Gram-positive isolates were 35 (41.2%) and Gram-negative were 50 (58.8%). There was equal distribution of acute and chronic wounds. Pseudomonas aeruginosa was the most common isolate at 30.6%, followed by Staphylococcus aureus (27.1%), Escherichia coli (9.4%), Streptococcus species (8.2%), and Morganella morganii (7.1%). The isolates demonstrated resistance to amoxicillin-clavulanate, ampicillin, cloxacillin, cefuroxime, ceftazidime; low-to-moderate sensitivity to erythromycin, gentamicin, streptomycin, tetracycline, ciprofloxacin, and ofloxacin; and a moderate sensitivity to ceftriaxone and a high sensitivity to imipenem. There was significant difference in antibiotic resistance patterns between Gram-positive isolates from acute and chronic wound infections but not for acute and chronic wound Gram-negative isolates.Conclusion:Most of the microbial isolates, particularly the Gram-negative isolates demonstrated low sensitivity to commonly used antibiotics and moderate-to-high sensitivity to less commonly used newer antibiotics.

Thickness and texture of the squamous temporal bone in a Nigerian tertiary hospital

Background: Thickness and texture of the squamous temporal bones (STBs) are the two main patient factors that determine the outcome of transtemporal transcranial Doppler ultrasound. The aim of this study was to determine the thickness and texture of the STB as well as their association with biodemographic characteristics in a tertiary hospital in Southwest Nigeria. Material and Methods: Cranial computed tomography (CT) images of 142 adults acquired on a 64-slice multi-detector Toshiba Aquilion scanner were retrospectively evaluated for the thickness and texture of the bilateral STB at the expected location of the temporal acoustic window on a ClearCanvas® Workstation. Associations of thickness and texture of the STB with biodemographic data were determined by statistical analysis at P Results: There were 79 male (55.6%) participants and the overall mean age was 51 ± 17.3 years (49 ± 16.1 years in males and 53.4 ± 18.5 years in females). Mean thickness of the 284 STB was 3.21 ± 1.11 mm (range 1.2–8.7 mm), which was thicker on the left (3.3 ± 1.2 mm) than the right (3.1 ± 1.0 mm, P = 0.001). Thickness of STB showed significant increase (P Conclusion: Thickness of the squamous temporal bone varied significantly with age but not with gender, and the temporal squama were largely of a homogeneous texture. Overall, the important patient factors appear favorable for transtemporal cranial ultrasound in the majority of our participants.

Multiple antibiotic resistance iIndex of EscherichiaColi isolates in a tertiary hospital in south-west Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Background: The effectiveness of available antibiotics is reducing as microorganisms device means of evading its effects, resulting in the development of superbugs. Pathogens previously susceptible are becoming resistant, and spreading beyond the hospital environment. This change is a major concern for infection control and prevention and a huge economic burden for health care. This study aims to determine the drug sensitivity pattern of E. coli isolated in a tertiary hospital labMethodology: Gram negative bacilli, lactose fermenter, motile, indole positive, glucose fermenter, gas producing isolate were identified as E.coli. Antimicrobial susceptibility testing to commonly prescribed antibiotics was carried out using the modified Kirby Bauer method and reported with the Clinical and Laboratory Standard Institute Interpretative chart. Mulitiple Antibiotic Resistance index was calculated as number of antibiotics to which isolate is resistant divided by the total number of antibiotics against which isolate was tested.Result: Five hundred and twenty–seven isolates were identified, among which a high rate of resistance to cefuroxime (407), high rate of intermediate susceptibility to nalidixic acid (264) and high rate of sensitivity to ceftriaxone (388) was noted. Sixty percent of the isolates had an index 0.2. Of the 40% with Multiple Antibiotic Resistance index &gt; 0.2, 61 % were from inpatient samples.Conclusion: The high Multiple Antibiotic Resistance index of the E. coli isolates indicates previous exposure to antibiotics and development of resistance to commonly prescribed antibiotics, hence, antimicrobial susceptibility testing is imperative in selecting therapeutic options. Attention also needs be paid to effective infection control and prevention to curb its spread among individuals.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Multiple Antibiotic Resistance Index of Escherichia Coli Isolates in a Tertiary Hospital in South-West Nigeria

Background: The effectiveness of available antibiotics is reducing as microorganisms device means of evading its effects, resulting in the development of superbugs. Pathogens previously susceptible are becoming resistant, and spreading beyond the hospital environment. This change is a major concern for infection control and prevention and a huge economic burden for health care. This study aims to determine the drug sensitivity pattern of E. coli isolated in a tertiary hospital lab&#x0D; Methodology: Gram negative bacilli, lactose fermenter, motile, indole positive, glucose fermenter, gas producing isolate were identified as E.coli. Antimicrobial susceptibility testing to commonly prescribed antibiotics was carried out using the modified Kirby Bauer method and reported with the Clinical and Laboratory Standard Institute Interpretative chart. Mulitiple Antibiotic Resistance index was calculated as number of antibiotics to which isolate is resistant divided by the total number of antibiotics against which isolate was tested. &#x0D; Result: Five hundred and twenty–seven isolates were identified, among which a high rate of resistance to cefuroxime (407), high rate of intermediate susceptibility to nalidixic acid (264) and high rate of sensitivity to ceftriaxone (388) was noted. Sixty percent of the isolates had an index ≤ 0.2. Of the 40% with Multiple Antibiotic Resistance index &gt; 0.2, 61 % were from inpatient samples.&#x0D; Conclusion: The high Multiple Antibiotic Resistance index of the E. coli isolates indicates previous exposure to antibiotics and development of resistance to commonly prescribed antibiotics, hence, antimicrobial susceptibility testing is imperative in selecting therapeutic options. Attention also needs be paid to effective infection control and prevention to curb its spread among individuals.

A multi-site assessment of knowledge of Ebola virus disease among health workers in south-west Nigeria

Objective: Nigeria may have been certified free from Ebola Virus Disease (EVD) by the World Health Organization, but not without its aftermath on many, especially among health workers who came in contact with the infected during the West African outbreak in 2014.This study was conducted among health workers in three tertiary hospitals in South-West Nigeria. It aimed at assessing their knowledge of EVD in a bid to forestall future contagion from patients. Method: 600 consenting participants selected through two-stage sampling method were involved in the study. Primary data was retrieved through self-administered questionnaire. Results: Majority (84.0%) of the participants knew that EVD can be contacted through blood and bodily fluid of an infected person, (78.0%) knew that EVD can be prevented by avoiding contact with an infected person, while (76.0%) identified bleeding from orifices as one of the signs of EVD. However, (6.0%) of the participants did not know how EVD can be prevented. Conclusion: Result showed that participants have average knowledge of EVD and therefore, are not adequately informed of EVD. The study recommended wider dissemination of adequate information on EVD among health workers in tertiary hospitals to forestall future contagion of the infection from patients. Keywords: Knowledge, EVD, Contagion, Outbreak, Prevention, Bleeding

Influence of Family Dynamics on Medication Adherence among Hypertensive Patients in a Tertiary Hospital in South-West Nigeria

Influence of Family Dynamics on Medication Adherence among Hypertensive Patients in a Tertiary Hospital in South-West Nigeria

Molecular screening of antibiotic-resistant determinants among multidrug-resistant clinical isolates of Proteus mirabilis from SouthWest Nigeria.

Globally, and particularly in developing countries, the menace of anti-microbial resistance is an accelerating problem. In Nigeria, increase in bacterial resistance has been phenotypically established but due to high cost, few molecular studies have been reported. This study screened for presence of transferable resistance genes and mobile genetic elements (MGEs) such as integron among multi-drug resistant (MDR) P. mirabilis. A total of 108 P. mirabilis strains collected from five tertiary hospitals in SouthWest Nigeria were subjected to antibiotic susceptibility study using disc-diffusion method. Transferable resistance genes and MGEs were amplified using Polymerase chain reaction (PCR) analysis and amplicons sequenced. Varied resistance was observed against all the antibiotics tested. About 56% of the isolates were MDR including those from 0-12 years old children. PCR analysis revealed the presence of aac(6')-Ib (33.3%), plasmid mediated quinolone resistance (PMQR) genes [qnrA (36.7%), acc(6')-Ib-cr (5%)], TEM (48.3%), CTX-M (6.7%) and integrons class 1 (58.3%) and class 2 (26.7%). Sequencing analysis revealed blaTEM-1, blaCTX-M-15 associated with ISEcp1 and eight different arrays of gene cassettes: aadA1, aadA1-qacH, aadB-aadA2, aadA5, dfrA7, dfrA15, dfrA17, dfrA17-aadA5. Transferable resistance genes in association with MGEs are present in Nigerian P. mirabilis thus their potential in disseminating resistance.

A cost analysis of road traffic injuries in a tertiary hospital in south-west Nigeria

This study examines the burden of road traffic injuries (RTIs) among road crash victims in a tertiary hospital in Ibadan, Nigeria. The study adopted a purposive sampling method to obtain primary data. Interview was done with 266 RTI victims who were admitted to the University College Hospital, Ibadan and discharged between March and May, 2015, using a structured questionnaire. From the data obtained, the study carried out descriptive statistical analyses. The results showed that the average cost per patient for RTI treatment was ₦ 42,946 ($215.9); on average, the amount expended on surgery was the highest followed by wound dressing and drugs; and the prevalence of catastrophic out-of-pocket (OOP) expenditure was over 86%. It is recommended that given the high burden of OOP hospital expenditure associated with RTI, there is need to implement more effective financial protection mechanisms against the high OOP expenditure faced by crash victims.

Cecal intubation rate during colonoscopy at a tertiary hospital in South-West Nigeria: How frequent and what affects completion rate?

Colonoscopy is useful in the diagnosis, treatment of colorectal diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). This was to assess the CIR at our endoscopy unit and evaluate the factors responsible for uncompleted cases. This was a prospective study at the endoscopy unit of the University College Hospital, Ibadan. All consenting patients referred for colonoscopy were recruited into the study. Colonoscopy was performed per protocol, and cecal intubation was considered successful when the medial wall of the cecum was intubated. Total of 305 colonoscopies were performed comprising 168 (55.1%) males and 137 (44.9%) females. Mean age was 57.5 ± 14.0 years (range 15-90 years). The crude CIR was 89.2%, whereas the adjusted CIR was 95.1%. Completion rate was higher in males, in patients who were younger than 58 years and in patients with adequate bowel preparation. CIR in our practice is high and comparable to the recommended rates. Female gender, age older than 58 years, and inadequate bowel preparation had a crude association with lower CIR, but this was not statistically significant.

Knowledge of Kidney Donation Among Care Givers in Two Tertiary Hospitals in Southwest Nigeria

One of the major challenges of kidney transplantation is shortage of kidney donors. Care givers (CGs) are potential kidney donors, but the majority of them are unwilling to donate due to inadequate knowledge on kidney donation. This study evaluated the knowledge of kidney donation and its determinants among CGs in two tertiary hospitals in Southwest Nigeria. This was a cross-sectional study that was carried out in the Kidney Care Centre (KCC), Ondo and Babcock University Teaching Hospital (BUTH), Ilishan-Remo using a self-administered pretested questionnaire that assessed knowledge of kidney donation and its determinants. Pvalue of <0.05 was taken as significant. A total of 244 respondents participated in the study. The majority were below 40 years, married, and female. The proportion of respondents with adequate knowledge of kidney donation was 63.4%. More respondents from BUTH compared to KCC had adequate knowledge of kidney donation (80% vs. 46.7%, P ≤ 0.001). Similarly, the mean knowledge score was higher in respondents from BUTH (P ≤ 0.001). Factors that determined knowledge of kidney donation were female gender (AOR: 3.43, 95% CI: 1.25-9.40, P = 0.02) and social class (AOR: 1.22, 95% CI: 0.50-2.95, P ≤ 0.001). There was positive correlation between knowledge of kidney donation among the respondents from both hospitals and their willingness to donate kidneys (r = 0.439, P ≤ 0.001). Knowledge of kidney donation was better among BUTH's respondents. Gender and social class were predictors of knowledge of kidney donation. Improving knowledge of kidney donation may improve willingness to donate among the public.

The Relationship between Central Retinal Artery Resistive Index and Measures of Renal Function in Type 2 Diabetes

Background: Renal and ocular vessels are some of the major vessels affected in patients with diabetes, and the involvement of these vessels is independent risk factors for other complications. Hemodynamic flow in arteries may be assessed by using measures such as resistive index, which is a non-invasive measure of the resistance in vessels. The association between retinopathy and nephropathy has been conflicting. This study assessed the relationship between resistive index of the central retinal artery and indices of nephropathy in type 2 diabetes. Method: This cross-sectional study examined 74 Nigerian diabetics who were selected consecutively from the out-patient diabetic clinic of a tertiary hospital in South-West Nigeria. Doppler ultrasound was used to determine the resistive index of the central retinal artery along with the right renal artery. The urinary and serum biochemical parameters were also done to determine the urinary albumin excretion and the glomerular filtration rate. Results: The mean age of participants was 59.62 ± 9.55 years. The mean central retinal artery resistive index (CRARI) was 0.77 ± 0.06, with 65 (87.8%) of the participants having elevated CRARI. There was no statistical difference between patients with normal CRARI and elevated CRARI in respect of their urinary albumin excretion (p = 0.796). There was no significant correlation between CRARI and estimated glomerular filtration rate (r = 0.120; p = 0.309) and right renal artery resistive index (r = 0.068; p = 0.564). Conclusion: This study demonstrates that central retinal artery resistive index (CRARI) may not be a predictor of renal function in diabetics.

Determinants of re-operation following tibia intramedullary nailing at a tertiary hospital in south-west Nigeria.

Introductionintramedullary nailing is a method of choice in the management of long bone diaphyseal fractures. However, complications necessitating re-operation may arise. This study was aimed at determining the rate and indications for re-operation following intramedullary nailing of tibia shaft fractures.Methodsit was a cross-sectional study done at Orthopaedic Department of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in Southwest Nigeria. Records of patients who had interlocking nailing for tibia shaft fracture between 2005 and March 2013 were retrieved. Variables of interest extracted included aetiology of fracture, type of fracture, cadre of surgeon and indication for re-operation. Frequency distribution and chi-square analysis were done using SPSS version 22. Level of statistical significance was determined at p-value <0.05ResultsOne hundred and forty-six patients had tibia nailing done during the study period. Eighty-six patients met the study criteria with male to female ratio of 2.6:1. There were 51 (59.3%) with open fractures and 35 (40.7%) with closed fractures. Ten patients had re-operation giving a re-operation rate of 11.6 %. Two most common indications for re-operation included loose screw 3 (25%) and surgical site infection (SSI) 3 (25%). There was no statistically significant association between rate of re-operation and the cadre of surgeon (p=0.741) and type of fracture whether closed or open (p=0.190).ConclusionRe-operation following tibia intramedullary nailing is an ever present risk. Precautions should be taken to prevent the common indications such as loose screw and surgical site infections.

Risk Factors, Clinical Features, Baseline Alanine Aminotransferase and CD4&amp;lt;sup&amp;gt;+&amp;lt;/sup&amp;gt; Count of Children with HIV Co-Infection with Hepatitis B and C at a Tertiary Hospital in Southwest Nigeria

Background: Human immunodeficiency virus and hepatitis B and C viruses are endemic in sub- Saharan African countries including Nigeria. Researchers have studied the burden of co-infection of HIV with hepatitis B and hepatitis C but the risk factors and clinical presentation have not been much addressed especially in children. Methodology: This was a prospective cross sectional study that determined the prevalence, risk factors, clinical features, baseline CD4+ count, CD4+ percentage, and alanine aminotransferase (ALT) of newly diagnosed, HAART na?ve HIV co-infection among children who were managed at a Tertiary Hospital in Ilorin, Nigeria. Result: Of the 60 HIV- infected children recruited, 11.7% had HIV co-infection with HBV or HCV. Children with co-infec- tions (mean age 8.43 ± 2.37 years) were significantly older than their HIV mono-infected counterparts (mean age 5.25 ± 3.96 years) (p = 0.011). There was no significant difference between HIV monoinfection and HIV co-infection with respect to gender (p = 0.758), ethnicity (p = 0.707), religion of parents (p = 0.436), family type (p = 0.184), social class (p = 0.535), previous transfusion (p = 0.053), scarification (p = 0.612), female genital mutilation (p = 0.778), and sharing of clippers (p = 0.806). The mean BMI, immunological staging (p = 0.535), baseline ALT (p = 0.940), and mean baseline CD4+ count (p = 0.928) were comparable. However, the body mass index of HIV co-infec- ted children decreased with age up till age 10 years. Conclusion: There were no risk factors, nor clinical features predictive of co-infection identified in this study. Co-infection did not negatively impact baseline, CD4+ count and ALT.

Profile of non-accidental childhood injury at a tertiary hospital in south-west Nigeria.

Injury threatens children lives worldwide. Most studies from Nigeria have been on accidental injuries in children. To study the profile of non-accidental injuries among children receiving care at a tertiary hospital in Nigeria. Children with non-accidental injuries were serially recruited and studied. The Paediatrics Trauma Score (PTS) was tested against the outcome. Non-accidental injuries accounted for 0.84% of all 5264 patients and 21.3% of the 207 injured. The case fatality rate was 6.8%. Physical abuse, sexual assault, drowning/near drowning, gunshot, poisoning and human bite caused the injuries in 68.2, 13.6, 6.8, 4.5, 4.5 and 2.3%, respectively. One-way analysis of variance and Tukey post hoc analysis showed that the mean PTS score of patients who died was significantly lower than the scores of those who were either discharged home or who discharged against medical advice (p < 0.001). The burden of non-accidental childhood injuries was high in the study area.