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Oladele Simeon Olatunya,1,2 Adefunke Olarinre Babatola,1,2 Adewuyi Temidayo Adeniyi,1,2 Olubunmi Adeola Lawal,3 Alaba Olanrewaju Daramola,4 Tosin Anthony Agbesanwa,5 Temitope Olumuyiwa Ojo,6 Paul Oladapo Ajayi,7 Adeleke Ajayi Ibijola,8 Akinwumi Kolawole Komolafe,2 Adekunle Adekile9 1Department of Paediatrics, College of Medicine, Ekiti State University, Ado Ekiti, Nigeria; 2Department of Paediatrics, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria; 3Department of Paediatrics, Federal Teaching Hospital, Ido Ekiti, Ekiti State, Nigeria; 4Department of Hematology and Blood Transfusion, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria; 5Department of Family Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria; 6Department of Community Health, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun State, Nigeria; 7Department of Community Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria; 8Department of Hematology, Federal Teaching Hospital, Ido Ekiti/Afe Babaloa University, Ado Ekiti, Ekiti State, Nigeria; 9Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, KuwaitCorrespondence: Oladele Simeon OlatunyaDepartment of Paediatrics, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti State, NigeriaTel +2348038617705Email ladeletunya@yahoo.comBackground: Due to the chronic nature of sickle cell disease (SCD), affected individuals may seek help from diverse places thus raising the need to understand their health-seeking behavior (HSB) in order to design an appropriate management policy for them.Aim: The aim of this study was to evaluate the HSB among pediatric SCD patients relative to their non-SCD counterparts attending a tertiary facility in Southwest Nigeria and identified predictors of poor HSB among SCD patients.Methods: A total of 110 children with SCD were recruited and studied for their HSPs which were compared with 110 non-SCD patients with other chronic medical conditions. Questionnaires were used to obtain self-reported information on participants’ socio-demographic data and HSB. Logistic regression was used to determine the predictors of poor HSB among the SCD cohort.Results: More SCD patients received treatments at private hospitals, patent medicine stores and faith-based centers compared to their non-SCD counterparts (p=0.0052; 0.006; and 0.007), respectively. No difference was observed in the patronage of traditional care centres 10 (9.1%) vs 6 (5.5%). More SCD patients 61 (55.5%) vs 35 (31.8%) exhibited poor HSB (p=0.0004). SCD patients who were not enrolled on health insurance scheme were 18 times more likely to have poor HSB (OR=18.38, 95% CI (4.41– 76.57), p value= < 0.0001) while absence of VOC within the preceding year reduces the risk of poor HSB by 91.5% (OR=0.085, 95% CI (0.028– 0.258), p value= < 0.0001).Conclusion: SCD patients in the study locality had poor HSB. This raises the need for their education on proper HSB. More enrollment into health insurance scheme and the prevention of VOC will lessen the burden of poor HSB. The high patronage of non-hospital care facilities in this study raises the need for stakeholders to monitor activities and train the operators at these informal care centres.Keywords: sickle cell disease, health-seeking behavior, non-orthodox care, Nigeria

Knowledge and implications of atrazine in waters from rural areas in Nigeria remain diminutive. Meanwhile, recent findings have shown presence of atrazine residue in water bodies. Atrazine level in six communities (Mamu, Oru, Ilaporu, Awa, Ijebu Igbo, and Ago-Iwoye) of Ijebu North local government, Ogun State, Nigeria using 69 hand-dug wells (HDWs), 40 boreholes (BHs) and four streams are monitored. Value of atrazine recorded was employed to appraise the implication on some hematological and biochemical parameters in relation to human health through dermal and ingestion contact using male albino rats. Highest atrazine of 0.08 mg/L was found in HDW of Ago-Iwoye out of 41 hand dug wells assessed, alongside 22 BH and four streams tested positive to atrazine, while the Oru documented lowest concentration with 0.01 mg/L. Ingestion and dermal hazard index (HI) were lower in adults than children and below acceptable limits in each community. Atrazine concentration at 0.01, 0.03, 0.04, and 0.08 mg/L in waters may not induce significant alteration in the hematological and some biochemical parameters of the exposed animal, while concentration at 0.04 and 0.08 mg/L might alter the blood glucose, albumin, and bilirubin. This is the first study to report atrazine in rural community waters in relation to human health in Nigeria.

Global efforts to combat epidemic cholera outbreaks have witnessed tremendous feats over the decades. However, sporadic outbreaks in regions, particularly across African states, mask these advancements. This regressive trend is frequently fuelled by factors retarding efforts towards optimal environmental sanitation and personal hygiene, which include ingesting infected food, drinking contaminated waters, and engaging in unhealthy environmental practices such as indiscriminate waste and sewage disposal and poor toilet practices. The ongoing efforts to achieve the Global Taskforce on Cholera Control (GTFCC) targets of a 90% reduction in cases and deaths by 2030, even in the wake of continuous outbreaks across various African regions, as reported by the World Health Organization (WHO) face a significant threat. One such effort, among others, is the AFRICHOL project, an enhanced cholera surveillance consortium launched in Africa over a decade ago as part of the GTFCC at WHO to monitor and fast-track the GTFCC's 2030 targets. It is tasked with supporting the implementation of research-based strategies for combating cholera in Africa. The prequalified oral cholera vaccines - Dukoral, Shanchol, and Euvichol - and those with recombinant DNA technology have also emerged as remarkable strides. In the face of this progress, challenges persist. Climate change, including extreme weather events and the lack of safe water, sanitation, and hygiene facilities, acts as a multiplier, amplifying existing challenges and hindering progress. Porous borders with inefficient disease surveillance networks among member states also facilitate the inter-territorial spread of the disease. Despite ongoing challenges, global targets are achievable provided strong institutional infrastructure and additional evidence-based public health initiatives are promulgated and enacted. The Global Roadmap to Ending Cholera Outbreaks by 2030 is a resourceful tool for advancing this fight and eradicating cholera., Competing Interests: Conflicts of interest: None.

Purpose: Patients with coronary artery disease (CAD) experience significant angina symptoms and lifestyle changes. Revascularization procedures can result in better patient-reported outcomes (PROs) than optimal medical therapy (OMT) alone. This study evaluates the impact of response shift (RS) on changes in PROs of patients with CAD across treatment strategies., Methods: Data were from patients with CAD in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease (APPROACH) registry who completed the 16-item Canadian version of the Seattle Angina Questionnaire at 2 weeks and 1 year following a coronary angiogram. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across treatment groups at week 2. Longitudinal MG-CFA was used to test for RS according to receipt of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical therapy (OMT) alone., Results: Of the 3116 patients included in the analysis, 443 (14.2%) received CABG, 2049(65.8%) PCI, and the remainder OMT alone. The MG-CFA revealed a partial-strong invariance across the treatment groups at 2 weeks (CFI = 0.98, RMSEA [90% CI] = 0.05 [0.03, 0.06]). Recalibration RS was detected on the Angina Symptoms and Burden subscale and its magnitude in the OMT, PCI, and CABG groups were 0.32, 0.28, and 0.53, respectively. After adjusting for RS effects, the estimated target changes were largest in the CABG group and negligible in the OMT group., Conclusion: Adjusting for RS is recommended in studies that use SAQ-CAN to assess changes in patients with CAD who have received revascularization versus OMT alone., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Health behaviors, such as diet and exercise, are actions individuals take that can potentially impact gastrointestinal (GI) symptoms and the gut microbiota. Little is known about how health behaviors impact GI symptoms and the gut microbiota after anti-cancer therapies., Methods: This is a secondary analysis of a cross-sectional study that investigated relationships between GI symptoms, gut microbiota, and patient-reported outcomes in adult cancer survivors. Gut microbiota was assessed from stool samples using 16 S rRNA gene sequencing. GI symptoms and health behaviors were measured via self-report. Descriptive statistics, multiple regression, and correlation analyses are reported., Results: A total of 334 cancer survivors participated, and a subsample of 17 provided stool samples. Most survivors rated their diet as moderately healthy (55.7%) and reported engaging in low intensity exercise (53.9%) for ≤5 h/week (69.1%). Antibiotic use was associated with more belly pain, constipation, and diarrhea ( P < .05). Survivors consuming a healthier diet had fewer symptoms of belly pain ( P = .03), gas/bloating ( P = .01), while higher protein consumption was associated with less belly pain ( P = .03). Better diet health was positively correlated with Lachnospiraceae abundance, and negatively with Bacteroides abundance ( P < .05). Greater exercise frequency positively correlated with abundance of Lachnospiraceae, Faecalibacterium, Bacteroides, Anaerostipes, Alistipes , and Subdoligranulum ( P < .05)., Conclusion: Results provide evidence for associations between antibiotic use, probiotic use, dietary health behaviors, and GI symptoms. Diet and exercise behaviors are related to certain types of bacteria, but the direction of causality is unknown. Dietary-based interventions may be optimally suited to address survivors' GI symptoms by influencing the gut microbiota. Larger trials are needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Admissions over the years have been largely due to preventable aetiologies and the possible outcomes are discharge, death, referral or discharge against medical advice. This study aimed to understand the patterns of postneonatal paediatric admissions and outcomes from a public tertiary health facility in South-West Nigeria., Methodology: A descriptive retrospective study of paediatric admissions over a 2-year period. Information concerning age, sex, diagnosis and outcome were extracted from patients' medical records. Data was presented in numbers and percentages, Chi-square was used to compare groups and a p-value of <0.05 was accepted as significant., Results: There were a total of 875 admissions, over the 24 months period, with a male-female ratio of 1.3:1. Malaria, sepsis, sickle cell crises, pneumonia, pharyngotonsilitis and acute watery diarrhoea constituted the six leading causes of all admissions. The mortality rate for all admissions was 5.0% while the under-five mortality rate was 3.9%. Seven hundred and ninety nine (91.3%) of the admitted patients were discharged, 44 (5.0%) died, 30 (3.4%) DAMA and two (0.3%) patients were referred., Conclusion: A large percentage of children still die from preventable and treatable diseases. Prompt health seeking behaviour, enrollment of more citizens on insurance scheme, and adoption of the newly developed malaria vaccine will help reduce child mortality. Also, early referral of patients by private hospitals should be encouraged and paediatricians to have a high index of suspicion for the diagnosis of septicaemia., Competing Interests: There are no conflicts of interest., (Copyright © 2023 Nigerian Medical Association.)

Background: Neonatal sepsis is an invasive infection of the bloodstream in neonates and a leading cause of morbidity and mortality among them., Aim: To investigate the role of procalcitonin (PCT) and C-reactive protein (CRP) in the management of neonatal sepsis., Materials and Methods: This was a prospective case-control study over one-year period using convenience sampling. Blood samples for PCT and CRP were taken from all neonates, while blood culture and white blood cell count samples were additionally taken from babies with neonatal sepsis. PCT and CRP were repeated at 24 and 48 hours. The continuous variables were found to have a nonparametric distribution. They were presented as median and interquartile range, and compared using Wilcoxon signed rank and Friedman test as appropriate., Results: The blood culture analysis yielded a prevalence of 12.7% with Staphylococcus aureus being the commonest organism. Baseline concentrations of PCT (1.28 ng/ml) and CRP (17.31 mg/L) in neonates with sepsis were higher than that of controls (PCT-0.63 ng/ml, CRP-5.40 mg/L). PCT concentrations decreased after two days of antibiotic treatment, while CRP concentrations decreased after a day. The concentration of both decreased to normal levels after two days of treatment., Conclusion: This study showed that CRP was more reliable in monitoring antibiotic therapy, unlike other studies which suggested PCT. In cases where the management of neonatal sepsis may be limited by a low blood culture yield, therapeutic monitoring may be aided by CRP and/or PCT., (Copyright © 2023 Copyright: © 2023 Nigerian Journal of Clinical Practice.)

Background: With the seemingly increasing trend of childhood hypertension, high serum uric acid (SUA) levels might be an indicator of essential hypertension among adolescents., Objective: To determine the SUA levels of hypertensive students and randomly selected controls and find the association, if any, between SUA level and blood pressure (BP) among secondary school students in Ido-Osi Local Government Area (LGA)., Methodology: The study was a nested case-control study conducted among selected secondary school students in IdoOsi LGA from June 2017 to March 2018. Of the 573 students screened for hypertension, SUA was assayed from 31 hypertensive students and an equal number of age- and sexmatched controls. Serum uric acid greater than 5.5 mg/ dL was taken as high. Statistical analysis included chi-square and Pearson correlation., Results: There was a positive correlation between SUA level and both systolic BP (p < 0.013) and diastolic BP (p < 0.017). The mean (SD) serum uric acid level of the hypertensive students [5.39 (2.08) mg/ dL] was higher than that of the controls [4.24 (1.81) mg/ dL] (p = 0.023). Hypertensive students with hyperuricaemia had a higher mean (SD) systolic BP than those with low uric acid: 138.67 (14.81) versus 128.68 (10.04); p =0.037., Conclusion: The mean serum uric acid level of students with hypertension was higher than that of the non-hypertensive students and high SUA levels appear to more prominently affect systolic than diastolic blood pressures among the cohort of hypertensive students., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Background: Human milk bank is a sustainable source of donor human milk (DHM) which is an acceptable alternative to the mother's milk and it is not routinely available in Nigeria, a multi-ethnically diverse country.The study aimed to assess the willingness to donate or accept human milk among pregnant women and mothers attending the antenatal, immunization, outpatient, under-five, and neonatal follow-up clinics in selected health facilities in Ekiti State, Southwest Nigeria., Study Design and Methods: A descriptive cross-sectional, mixed methods study design was used to collect data in selected health facilities in Ekiti State. Questionnaires and focus group discussions were used to collect quantitative and qualitative data respectively while data analysis was done using the IBM® Statistical Package for Social Science SPSS version 26® and thematic analysis respectively., Results: Of the 798 respondents, 529 (66.3%) and 626 (78.4%) did not know about wet nursing or human milk banking (HMB) respectively and 139 (17.4%) were willing to donate their breastmilk for a stipend. In the focus group discussion, 50% had heard about wet nursing but none heard about HMB. Maternal educational level had a significant impact on their willingness to donate or accept DHM ( p  < 0.00). Wholesomeness, cultural, and religious biases were major reasons affecting HMB acceptability., Conclusions: Awareness and perception of HMB are poor. Appropriate information, education, and counselling on HMB are needed to drive the adoption and establishment of HMB in Nigeria., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Introduction: Sensuality, an essential component of sexuality, is the enjoyment, expression, or pursuit of physical and sexual pleasure or satisfaction. Sensuality expression of women over 50 is under-researched and often ignored, making it difficult to have a scientific basis to develop age-appropriate healthy-ageing programmes for this group in Nigeria. An exploratory study was conducted to explore the lived experiences of the expression of sensuality of Nigerian women over 50 and the meaning they attach thereto., Methodology: An Interpretative Phenomenological Analysis approach was used to collect and analyze data from 17 female teachers from three public secondary schools in Osun state, Nigeria, to represent a homogenous group of professional women over the age of 50. A semi-structured questionnaire was used to obtain qualitative data that was thematically analyzed., Findings: Four superordinate themes emerged: 'Self-reinvention to camouflage ageing realities for sensuality expression'; 'Embracing own sensuality'; 'Yearning for old self'; and 'Loss of interest in romantic relationships', with various subordinate themes., Conclusion: These finding provide the basis to develop age-appropriate healthy-ageing programmes for this group, and a baseline for further sexual health research among this group of women in Nigeria, who are often overlooked or considered asexual due to their being beyond the reproductive age., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Lawal, Duma. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: School environment entails the sum total of the physical, biological, social, and emotional environment within which members of the school community operate. It is essential to make the school environment healthy to promote and protect the health of school pupils as well as their safety. This study aimed at finding the level of implementation of a Healthy School Environment (HSE) in Ido/Osi Local Government Area (LGA) of Ekiti State., Methodology: A cross-sectional descriptive study carried out among 48 private and 19 public primary schools using a standardised checklist and direct observation., Results: The teacher-to-pupil ratio was 1:16 in public schools and 1:10 in private schools. The leading source of water in 47.8% of the schools was well water. Most, 97%, of the schools practiced open dumping of refuse. Private schools had more school buildings with strong walls and good roofs with doors and windows which provided adequate ventilation compared to the public schools (p- 0.001). No school was located close to an industrial area, however, none had a safety patrol team. Only 34.3% of schools had a fence and 31.3% had terrains prone to flooding. Only 3% of the schools, all private schools, attained the minimum acceptable score on the school environment., Conclusion: The status of school environment was poor in the study location and school ownership did not make any much impact as there was no difference in the situations of school environment between public and private schools., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Purpose: The Seattle Angina Questionnaire (SAQ) is a widely used patient-reported measure of health status in patients with coronary artery disease. Comparisons of SAQ scores amongst population groups and over time rely on the assumption that its factorial structure is invariant. This study evaluates the measurement invariance of the SAQ across different demographic and clinical groups and over time., Methods: Data were obtained from the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease registry, a registry of patients who received coronary angiogram in Alberta, Canada. The study cohort consists of adult patients who completed the paper-based version of the 16-item Canadian version of the SAQ (SAQ-CAN) 2 weeks and 1-year post-coronary angiogram between 2009 and 2016. Multi-group confirmatory factor analysis was used to assess configural, weak, strong, and strict measurement invariance across age groups, sex, angina type, treatment, and over time. Model fit was assessed using the comparative fit index and root mean square error of approximation., Results: Of the 8101 patients included in these analysis, 1300 (16.1%) were at least 75 years old, while 1755 (21.7%) were female, 5154 (63.6%) were diagnosed with acute coronary syndrome, 1177 (14.5%) received coronary artery bypass graft treatment, and 3279 had complete data on the SAQ-CAN at both occasions. There was evidence of strict invariance across age, sex, and angina type, and treatment groups, but partial strict invariance was established over time., Conclusion: SAQ-CAN can be used to compare the health status of coronary artery disease patients across population groups and over time., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: We aimed to assess the reliability and validity of single-item global ratings (GR) of satisfaction with epilepsy surgery., Methods: We recruited 240 patients from four centers in Canada and Sweden who underwent epilepsy surgery ≥1 year earlier. Participants completed a validated questionnaire on satisfaction with epilepsy surgery (the ESSQ-19), plus a single-item GR of satisfaction with epilepsy surgery twice, 4-6 weeks apart. They also completed validated questionnaires on quality of life, depression, health state utilities, epilepsy severity and disability, medical treatment satisfaction and social desirability. Test-retest reliability of the GR was assessed with the intra-class correlation coefficient (ICC). Construct and criterion validity were examined with polyserial correlations between the GR measure of satisfaction and validated questionnaires and with the ESSQ-19 summary score. Non-parametric rank tests evaluated levels of satisfaction, and ROC analysis assessed the ability of GRs to distinguish among clinically different patient groups., Results: Median age and time since surgery were 42 years (IQR 32-54) and 5 years (IQR 2-8), respectively. The GR demonstrated good to excellent test-retest reliability (ICC = 0.76; 95% CI 0.67-0.84) and criterion validity (0.85; 95% CI 0.81-0.89), and moderate correlations in the expected direction with instruments assessing quality of life (0.59; 95% CI 0.51-0.63), health utilities (0.55; 95% CI 0.45-0.65), disability (-0.51; 95% CI -0.41, -0.61), depression (-0.48; 95% CI -0.38, -0.58), and epilepsy severity (-0.48; 95% CI -0.38, -0.58). As expected, correlations were lower for social desirability (0.40; 95% CI 0.28-0.52) and medical treatment satisfaction (0.33; 95% CI 0.21-0.45). The GR distinguished participants who were seizure-free (AUC 0.75; 95% CI 0.67-0.82), depressed (AUC 0.75; 95% CI 0.67-0.83), and self-rated as having more severe epilepsy (AUC 0.78; 95% CI 0.71-0.85) and being more disabled (AUC 0.82; 95% CI 0.74-0.90)., Significance: The GR of epilepsy surgery satisfaction showed good measurement properties, distinguished among clinically different patient groups, and appears well-suited for use in clinical practice and research., (© 2022 International League Against Epilepsy.)

Objective: The relationship between antiseizure medications (ASMs), which improve health outcomes by controlling seizures, and health-related quality of life (HRQOL) is poorly understood and may involve intermediate variables. We evaluated the potential mediators of the association between ASMs and HRQOL., Methods: Data are from an outpatient registry of adult patients with epilepsy seen at the Foothills Medical Center, Calgary, Alberta, Canada. Quality of life was measured using the 10-item Quality of Life in Epilepsy, and depression was measured using the Neurological Disorders Depression Inventory for Epilepsy. Propensity score matching was used to adjust for covariate imbalance between patients who received a single ASM (monotherapy) and those who received two or more ASMs (polytherapy) due to confounding. Mediation analysis was used to estimate the mediating effects of depression and ASM side effects on the association between patients' ASM polytherapy and HRQOL., Results: Of 778 patients included in this analysis, 274 (35.2%) were on two or more ASMs. Patient-reported depression and ASM side effects jointly mediated the association between ASMs and HRQOL; these mediators accounted for 42% of the total average effect of ASM polytherapy ( β  = -13.6, 95% confidence interval = -18.2 to -8.6) on HRQOL., Significance: These findings highlight the importance of managing depression and ASM side effects for improving health outcomes of patients requiring treatment with ASMs. Intervention programs aimed at improving HRQOL of patients with epilepsy need to target these potential mediators., (© 2021 International League Against Epilepsy.)

Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria's national strategic health development plan 2018-2022 placed little emphasis on surgical care. To address the gap, we worked with professional societies and other partners to develop the national surgical, obstetric, anaesthesia and nursing plan 2019-2023. The aim was to foster actions to prioritize surgical care for the achievement of universal health coverage. In addition to creating a costed strategy to strengthen surgical care, the plan included children's surgery and nursing: two key aspects that have been neglected in other national surgical plans. Pilot implementation of the plan began in 2020, supported by a nongovernmental organization with experience in surgical care in the region. We have created specific entry points to facilitate the pilot implementation. In the pilot, an electronic surgery registry has been created; personnel are being trained in life support; nurses are being trained in safe perioperative care; biomedical technicians and sterile supplies nurses are being trained in surgical instrument repair and maintenance; and research capacity is being strengthened. In addition, the mainstream media are being mobilized to improve awareness about the plan among policy-makers and the general population. Another development partner is interested in providing support for paediatric surgery, and a children's hospital is being planned. As funding is a key challenge to full implementation, we need innovative domestic funding strategies to support and sustain implementation., ((c) 2021 The authors; licensee World Health Organization.)

Objective: The 19-item Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19) is a validated and reliable post hoc means of assessing patient satisfaction with epilepsy surgery. Prediction models building on these data can be used to counsel patients., Methods: The ESSQ-19 was derived and validated on 229 patients recruited from Canada and Sweden. We isolated 201 (88%) patients with complete clinical data for this analysis. These patients were adults (≥18 years old) who underwent epilepsy surgery 1 year or more prior to answering the questionnaire. We extracted each patient's ESSQ-19 score (scale is 0-100; 100 represents complete satisfaction) and relevant clinical variables that were standardized prior to the analysis. We used machine learning (linear kernel support vector regression [SVR]) to predict satisfaction and assessed performance using the R 2 calculated following threefold cross-validation. Model parameters were ranked to infer the importance of each clinical variable to overall satisfaction with epilepsy surgery., Results: Median age was 41 years (interquartile range [IQR] = 32-53), and 116 (57%) were female. Median ESSQ-19 global score was 68 (IQR = 59-75), and median time from surgery was 5.4 years (IQR = 2.0-8.9). Linear kernel SVR performed well following threefold cross-validation, with an R 2 of .44 (95% confidence interval = .36-.52). Increasing satisfaction was associated with postoperative self-perceived quality of life, seizure freedom, and reductions in antiseizure medications. Self-perceived epilepsy disability, age, and increasing frequency of seizures that impair awareness were associated with reduced satisfaction., Significance: Machine learning applied postoperatively to the ESSQ-19 can be used to predict surgical satisfaction. This algorithm, once externally validated, can be used in clinical settings by fixing immutable clinical characteristics and adjusting hypothesized postoperative variables, to counsel patients at an individual level on how satisfied they will be with differing surgical outcomes., (© 2021 International League Against Epilepsy.)

Objective: No validated tools exist to assess satisfaction with epilepsy surgery. We aimed to develop and validate a new measure of patient satisfaction with epilepsy surgery, the 19-item Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19)., Methods: An initial 31-item measure was developed based on literature review, patient focus groups, thematic analysis, and Delphi panels. The questionnaire was administered twice, 4-6 weeks apart, to 229 adults (≥18 years old) who underwent epilepsy surgery ≥1 year earlier, at three centers in Canada and one in Sweden. Participants also completed seven validated questionnaires to assess construct validity. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed the factorial structure of the questionnaire. Cronbach alpha and intraclass correlation coefficients (ICCs) assessed the internal consistency and test-retest reliability of the ESSQ-19. Spearman and polyserial correlations assessed construct validity., Results: Median age of participants and time since surgery were 42 years (interquartile range [IQR] = 32-54) and 5 years (IQR = 2-8.75), respectively. EFA and CFA yielded 18 items that segregated into four domains (mean score [SD]), namely, seizure control (76.4 [25]), psychosocial functioning (67.3 [26]), surgical complications (84 [22]), and recovery from surgery (73 [24]), one global satisfaction item, and a summary global score (74 [21]). The domain and summary scores demonstrated good to excellent internal reliability (Cronbach ⍺ range = .84-.95) and test-retest reliability (ICC range = 0.71-0.85). Construct validity was supported by predicted correlations with other instruments., Significance: The ESSQ-19 is a new, valid, and reliable measure of patient satisfaction with epilepsy surgery that can be used in clinical and research settings., (© 2020 International League Against Epilepsy.)

Background: The Seattle Angina Questionnaire (SAQ) is a widely-used patient-reported outcomes measure in patients with heart disease. This study assesses the validity and reliability of the SAQ in a Canadian cohort of individuals with stable angina., Methods and Results: Data are from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry, a population-based registry of patients who received cardiac catheterization in Alberta, Canada. The cohort consists of 4052 patients undergoing cardiac catheterization for stable angina and completed the SAQ within 2 weeks. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess the factorial structure of the SAQ. Internal and test-retest reliabilities of a new measure (i.e., SAQ-CAN) was measured using Cronbach α and intraclass correlation coefficient, respectively. CFA model fit was assessed using the root mean square error of approximation (RMSEA) and comparative fit index (CFI). Construct validity of the SAQ-CAN was assessed in relation to Hospital Anxiety and Depression Scales (HADS), Euro Quality of life 5 dimension (EQ5D), and original SAQ. Of the 4052 patients included in this analysis, 3281 (80.97%) were younger than 75 years old, while 3239 (79.94%) were male. Both exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 16 items that provided a better fit to the data (RMSEA = 0.049 [90% CI = (0.047, 0.052)]; CFI = 0.975). The 16-item SAQ demonstrated good to excellent internal reliability (Cronbach's α range from 0.77 to 0.90), moderate to strong correlation with the Original SAQ and EQ5D but negligible correlations with HADS., Conclusion: The SAQ-CAN has acceptable psychometric properties that are comparable to the original SAQ. We recommend its use for assessing coronary health outcomes in Canadian patients with Coronary Artery Disease.

Considering the global health threat posed by kidney disease burden, a search for new nephroprotective drugs from our local flora could prove a powerful strategy to respond to this health threat. In this study we investigated the antihyperuricemic and nephroprotective potential of RA-3, a plant-derived lanosteryl triterpene. The antihyperuricemic and nephroprotective effect of RA-3 was investigated using the adenine and gentamicin induced hyperuricemic and nephrotoxicity rat model. Following the induction of hyperuricemia and nephrotoxicity, the experimental model rats (Sprague Dawley) were orally administered with RA-3 at 50 and 100 mg/kg body weight, respectively, daily for 14 days. Treatment of the experimental rats with RA-3, especially at 100 mg/kg, effectively lowered the serum renal dysfunction (blood urea nitrogen and creatinine) and hyperuricemic (uric acid and xanthine oxidase) biomarkers. These were accompanied by increased antioxidant status with decrease in malondialdehyde content. A much improved histomorphological structure of the kidney tissues was also observed in the triterpene treated groups when compared to the model control group. It is evident that RA-3 possesses the antihyperuricemic and nephroprotective properties, which could be vital for prevention and amelioration of kidney disease.

Background: Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess the practice and perception of early SCD diagnosis among a group of parents and physicians in Nigeria. Patients and Methods . This was a cross-sectional descriptive study conducted to assess the opinions and practice of early diagnosis of SCD among 135 physicians caring for SCD patients and 164 mothers of children with SCD in a southwestern state of Nigeria., Results: Most physicians 132 (97.8%) were aware of prenatal SCD diagnosis, but only 51 (37.8%) would recommend it. Most physicians 129 (95.6%) routinely recommend premarital SCD genetic counseling and testing, and 89 (65.1%) were aware of the national government newborn screening program but lesser proportion 75 (55.6%) were willing to recommend it. Amongst the mothers, 154 (94%) and 158 (96%) had encountered genetic counseling for SCD and were willing to offer newborn screening to their children, respectively. On the contrary, fewer mothers 42 (25%) were aware of prenatal SCD diagnosis, 28 (17%) were willing to partake in it, and 44 (26%) were undecided. There were discrepancies in the willingness by physicians to practice early SCD diagnosis and its uptake by mothers ( p < 0.0001). The commonest reason given by both the physicians and mothers for not practicing SCD prenatal diagnosis was the high cost of the procedure., Conclusion: The perceptions and practice of early SCD diagnosis was suboptimal in the study locality. Scaling up awareness and universal coverage are required., Competing Interests: The authors declare no conflicts of interest with respect to this study., (Copyright © 2020 Oladele Simeon Olatunya et al.)

BACKGROUND Blood pressure (BP) is not routinely screened in children in clinical practice. Renal cell carcinoma (RCC) is a rare cause of renal hypertension and accounts for less than 0.3% of all childhood tumors. The clinical manifestation of hypertension in children requires a high index of suspicion, as does RCC, which can have many different manifestations. CASE REPORT We report the case of a 10-year-old girl with 1-year history of persistent symptoms of recurrent episodes of headache and excessive sweating and a 6-months history of weight loss and loss of appetite. She was repeatedly managed as having malaria in the center where she was referred, without recovery. Persistent high BP was discovered in our center, which ranged between 180/120 and 200/120 mmHg. This was not controlled by 3 different classes of drugs. Abdominal ultrasonography showed a right kidney with a well circumscribed lower pole mass with internal echoes, compressing the pelvicalyceal system. Abdominal computed tomography revealed a huge, circumscribed, expansile, isodense mass arising from the renal cortex in the lower pole of the right kidney. Intraoperative findings included a mass seen at the lower pole of the right kidney with histology diagnosis of RCC. Other laboratory tests were normal. To date, the patient remains normotensive and symptom-free after nephrectomy. CONCLUSIONS The nonspecific clinical manifestation found in this case show the need for hypertension screening in children. The resolution of symptoms after nephrectomy confirms RCC as the underlying cause of symptoms, making this case a unique presentation.

Purpose: Exercise intervention studies for brain health can be difficult to interpret due to heterogeneity in exercise intensity, exercise duration, and in adherence to the exercise intervention. This study aimed to characterize heterogeneity in these components in a cohort of healthy middle-age and older adults who participated in a prescribed 6-month supervised aerobic exercise intervention as part of the Brain in Motion study., Methods and Results: Group-based multitrajectory analysis (GBMTA) was used to characterize variation in the trajectory of exercise intensity and duration for male and female participants in the first 3 months of the exercise program. The GBMTA for males and females revealed two distinct trajectory subgroups, namely, "high-increasing" (HI) and "low-increasing" (LI). Logistic regression was used to assess the association between the identified latent subgroups and (i) demographic characteristics; (ii) physiological characteristics, including cardiovascular and cerebrovascular function; (iii) genetic characteristics; and (iv) adherence with American College of Sports Medicine guidelines on exercise for older adults. Of the 196 participants, 54.1% met the American College of Sports Medicine aerobic exercise targets for intensity and duration during the intervention. Aerobic fitness (maximal oxygen uptake; odds ratio, 1.27; P < 0.01) was significantly different between these trajectory subgroups in males, and cerebrovascular function (cerebrovascular resistance; odds ratio, 0.14; P < 0.01) was significantly different between these trajectory subgroups in females., Conclusion: This novel approach to tracking a prespecified exercise program highlights that there are individual and group-specific variations within a prescribed exercise intervention. Characterizing exercise adherence in this way holds promise in developing optimized exercise prescriptions tailored to individual baseline characteristics, and additionally highlighting those participants at greatest risk of not meeting minimum dosage requirements for physiological and/or cognitive health.

Ethnopharmacological Relevance: Bougainvillea glabra is widely used in Nigeria for the treatment of inflammatory-related conditions, and as remedy for pain ailments., Aim of the Study: Considering the lack of scientific studies focused on chemical constituents and pharmacological activity of B. glabra essential oil, this work was designed to characterize the volatile compounds and evaluate the anti-inflammatory and anti-nociceptive properties ascribed to this plant species., Materials and Methods: The essential oil was extracted from the leaf of B. glabra by hydrodistillation in an all glass Clevenger-type apparatus and characterized by gas chromatography (GC-FID) and gas chromatography-mass spectrometry (GC-MS) on HP-5 column. The anti-inflammatory property of the essential was established by measurement of carrageenan induced rat paw edema while the anti-nociceptive activity was determined by hot plate test, according to established procedures., Results: The essential oil was obtained in a yield of 0.08% (v/w) calculated on dry weight basis. A total of 11 compounds representing 96.2% of the oil contents were identified by GC/MS. The main constituents of the essential oil were (E)-nerolidol (31.4%), (E)-β-ionone (10.3%) and linalool (10.1%). The anti-nociceptive property of the essential oil was statistically significant p < 0.001 at all doses of when compared to the control while exhibiting an activity in tandem with the standard drug. For the 1st and 2nd h, at doses of 100 and 200 mg/kg, the anti-inflammatory activity was statistically very significant (p < 0.001), while at 3rd h the activity declined (p < 0.01) at a dose of 200 mg. The activity was non-significant at the 4th h experimental duration., Conclusions: This is first report on the chemical constituents and biological activity of essential oil of B. glabra from Nigeria. Overall, the results herein presented sustain and strengthen the anti-nociceptive and anti-inflammatory properties traditionally ascribed to B. glabra., (Copyright © 2018 Elsevier B.V. All rights reserved.)

In the original article there is an error in Fig. 2. Following is the corrected figure.

Background: This is a baseline assessment of surgical capacity in the Federal Capital Territory (FCT), in preparation for the creation of a National Surgical, Obstetric, Anesthesia, and Nursing Plan., Methods: In October 2017, all 10 of the 11 secondary hospitals in FCT that provide surgical and/or obstetric care were surveyed using a modified World Health Organization Hospital Assessment Tool and a qualitative semi-structured hospital interview tool of the medical Director (MdD). This project received approval from the Nigeria Federal Ministry of Health and the FCT Department of Health and Human Services., Results: The number of inpatient beds ranged from 35 to 140, and the number of admissions ranged from 1200 to 6400 patients per year. The mean number of surgeries performed in 2016 by these hospitals was 783 (range 235-1601). Cesarean section was the most common surgical procedure at each hospital. Only five hospitals regularly performed laparotomies. Only three hospitals regularly performed fixation of open fractures. Of 152 surgical, obstetric, and anesthesia providers, all hospitals had at least one consultant obstetrician, but only four hospitals had a general surgeon and three hospitals had a consultant anesthesiologist. Deficient physical space for inpatient admissions was the most common concern of MdDs., Conclusions: The FCT reaches the target for 2-h access, with 80% of patients (on average) reaching the hospital within 2 h. However, SAO provider density, surgical volume, and tracking of the perioperative mortality rate were low. Data were lacking to comment on protection against impoverishing and catastrophic expenditures.

Introduction: Micronutrient deficiencies are prevalent in developing countries and may influence vulnerability to diseases particularly malaria and its severity. This study investigated serum vitamin A profile of under-five children with severe malaria (SM) in South-western, Nigeria and to determine its association with degree of malaria parasitaemia, types of SM and eventual outcome., Methodology: Using HPLC, serum vitamin A concentrations of 170 under-five children with SM and 170 age- and gender-matched controls were determined. Parasite species identification and density were also determined. Association between serum vitamin A levels and the degree of parasitaemia, type of SM and patients' outcome were examined by both bivariate and logistic regression analyses., Results: Thirty-five (20.6%) of the children with SM compared with 3 (1.8%) of the controls had hypovitaminosis A, p <0.001, OR = 14.4, 95% Confidence Interval = 4.4 - 47.8. The mean serum vitamin A concentration was also lower in the patients (45.23µg/dL vs. 87.28µg/dL; p <0.001). There was inverse correlation between serum vitamin A levels and malaria parasite density (r = - 0.103, p = 0.027). Higher proportions of children with SM and hypovitaminosis A presented with metabolic acidosis and cerebral malaria (p <0.001 and 0.032 respectively). Children with SM and hypovitaminosis A were 9.1 times more likely to die compared to those without low serum vitamin A levels, OR = 9.1, 95% Confidence Interval = 2.2-38.1, p = 0.002., Conclusion: Children with SM had reduced serum vitamin A and significantly contributed to increased morbidity and mortality., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2018 Olubunmi Adeola Lawal, Samuel Ademola Adegoke, Saheed Babatunde Oseni, Oyeku A. Oyelami.)

The chemical constituents and anti-inflammatory activity of the essential oil from the leaf of Jatropha curcas L (Euphorbiaceae) collected from Nigeria are reported. The analysis of the chemical constituents of the essential oil was achieved by using gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). All constituents of the essential oil, namely neophytadiene (35.8%), phytol (23.1%), trans-pinane (12.7%), 6,10,14-trimethyl-2- pentadecanone (12:3%) and citronellyl propanoate (11.2%), were present in significant amounts. The anti-inflammatory activity of the leaf oil was determined on Wistar rats using egg-albumin as phlogistic agent; significant inhibition (P< 0.05) was shown at a dose of 2%, v/v. Percentage inhibition of the anti- inflammation increased steadily to 76.6% in the 4th hour.

The volatile constituents and insecticidal activity of the essential oil obtained by hydrodistillation of pulverized air-dried leaves of Dehinbolliapinnata Schum. & Thonn (Sapindaceae) growing in Nigeria were studied. The constituents of the oil were analyzed by gas chromatography (GC) aid gas chromatography coupled with mass spectrometry (GC-MS). The percentage yield of the oil was 0.04% (v/w). Fourteen compounds were characterized, representing 94.0% of the total volatile component of the oil. The major constituents of the oil were hexahydrofarnesyl acetone (37.5%), fainesyl acetone (17.2%) and geranyl acetone (14.6%). The essential oil, at a concentration of 120 mg/mL, displayed 100% mortality against Sitophilus zeamais at 72 h with a LC(50) > 40.00 mg/mL air.

Context: The current rapid increase in the incidence of cardiovascular events indicates a need for the discovery of more effective cardioprotective agents., Objective: This study evaluated the cardioprotective potential of a lanosteryl triterpene from Protorhus longifolia (Benrh.) Engl. stem bark., Materials and Methods: Spectroscopic data analysis was used to confirm the structure of methyl-3β-hydroxylanosta-9, 24-dien-21-oate (RA-3). The cardioprotective effect of RA-3 in isoproterenol-induced myocardial injury in hyperlipidemic rats was investigated. Rats were divided into the normal diet (ND) fed and high fat diet (HFD) fed groups. The HFD rats were further subdivided into three groups. The experimental group was orally administered with RA-3 (100 mg/kg) for 15 days. The rats were then injected with isoproterenol (85 mg/kg) to induce myocardial injury. At the end of the experiment, hearts and blood tissues were collected and used for histology and biochemical assays, respectively., Results: RA-3 exhibited a cardioprotective effect as it minimized myocardial injury in HFD rats. Few lesions of acute hyaline degeneration and reduced fat deposition were observed in the heart tissue of the triterpene pretreated rats. Lactate dehydrogenase (LDH) activity was decreased in the blood of the RA-3 pretreated rats (44.1 mU/mL) compared to the untreated group (64.8 mU/mL). Increased glutathione (GSH) content and catalase (CAT) activity along with lower levels of malondialdehyde (MDA) in the triterpene pretreated animals (120.8 nmol/μL) than in the non-treated HFD fed rats (143.6 nmol/μL) were also observed., Discussion and Conclusion: The cardioprotective effect exhibited by RA-3 indicates its potential use in the management of cardiovascular diseases (CVD) and related health problems.

Background: Safe, timely red blood cell transfusion saves lives and chronic transfusion therapy (CTT) prevents or limits morbidities such as stroke, therefore improving quality of life of patients with sickle cell disease (SCD)., Methods: This questionnaire-based study assessed the ability of sickle cell centers in Nigeria to provide safe blood to patients with SCD between March and August 2014., Results: Out of the 73 hospitals contacted, responses were obtained from 31. Twenty four (78%) hospitals were unable to transfuse patients regularly due to blood scarcity. Packed red blood cells were available in 14 (45%), while only one provided leukocyte-depletion. Most centers assessed donor risk and screened for HIV in 30 (97%), hepatitis B in 31(100%) and hepatitis C in 27 (87%) hospitals. Extended phenotyping and alloantibody screening were not available in any center. A quarter of the hospitals could monitor iron overload, but only using serum ferritin. Access to iron chelators was limited and expensive. Seventeen (55%) tertiary hospitals offered CTT by top-up or manual exchange transfusion; previous stroke was the most common indication., Conclusion: Current efforts of Nigerian public hospitals to provide safe blood and CTT fall short of best practice. Provision of apheresis machines, improvement of voluntary non-remunerated donor drive, screening for red cell antigens and antibodies, and availability of iron chelators would significantly improve SCD care in Nigeria., (© The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The essential oil constituents of the leaves of Jasminum subtriplinerve (Oleaceae) and Vitex quinata (Verbanaceae) cultivated in Vietnam were analysed by gas chromatography--flame ionisation detector (GC-FID) and gas chromatography--mass spectrometry (GC-MS) techniques. The main constituents identified in J. subtriplinerve were mainly oxygenated monoterpenes represented by linalool (44.2%), α-terpineol (15.5%), geraniol (19.4%) and cis-linalool oxide (8.8%). The quantitative significant components of V. quinata were terpene hydrocarbons comprising of β-pinene (30.1%), β-caryophyllene (26.9%) and β-elemene (7.4%). The chemical compositions of the essential oils are being reported for the first time.

This paper reports on the compounds identified in the leaf and flower essential oils obtained by hydrodistillation of Plumeria alba L. (Apocynaceae) grown in Nigeria. The chemical analysis of the essential oils was achieved by means of gas chromatography (GC) and gas chromatography coupled with mass spectrometry (GC-MS). Linalool (13.2%), n-nonanal (9.6%), phenyl acetaldehyde (8.5%), neryl acetone (5.3%) and n-decanal (5.1%) were the main constituents of the leaf oil. On the other hand, the flower oil comprised mainly of limonene (9.1%), linalool (7.9%), α-cedrene (8.0%), caryophyllene oxide (7.9%) and (E, E)-α-farnesene (6.6%). This is the first report on the essential oil constituents of P. alba.

The leaf essential oil of Parquetina nigrescens collected from Badary, Nigeria, was obtained by hydrodistillation and analyzed by gas chromatography - mass spectrometry. The essential oil had a simple composition with only five identified components. The oil was dominated by citral (35.0% neral and 53.7% geranial). The high concentration of citral in the essential oil likely contributes to the ethnomedicinal utility and bioactivities associated with this medicinal plant.

The chemical composition of essential oil obtained by hydrodistillation of the leaves of Pachira glabra Pasq., (PgEO) has been studied by Gas Chromatography (GC) and Gas Chromatography coupled with Mass Spectrometry (GC/MS). Thirty three constituents representing 98.4% of total contents were identified from the essential oil. The major constituents of oil were limonene (23.2%), β-caryophyllene (14.5%), phtyol (8.5%) and β-bisabolene (6.3%). The antimicrobial activity of the PgEO was evaluated against a panel of ten bacteria and three fungal strain using agar diffusion and broth microdilution methods. Results have shown that the PgEO exhibited moderate to strong antimicrobial activity against the tested microorganisms except Citrobacter youagae, Micrococcus spp. and Proteus spp. The activity zones of inhibition (ZI) and minimum inhibitory concentrations (MIC) ranged between 13.7 mm-24.0 mm and 0.3 mg/mL-2.5 mg/mL, respectively. The insecticidal activity of PgEO was assayed against the adult Sitophilus zeamais. The lethal concentrations (LC50 and LC90) of the PgEO showed it to be toxic against adult S. zeamais at 32.2 and 53.7 mg/mL, respectively. This is the first report on the chemical composition and in vitro biological activities of essential oil of P. glabra growing in Nigeria.

Introduction: The development and spread of Plasmodium falciparum resistance to most commonly used antimalarials remain a major challenge in the control of malaria. Constant monitoring of drug efficacy is an important tool in establishing rational antimalarial drug policies., Methodology: A randomized comparative study was conducted at the Wesley Guild Hospital, Ilesa, Nigeria between February 2010 and September 2011 comparing the efficacy and safety of artemether-lumefantrine (Coartem) and fixed dose of artesunate plus amodiaquine (Larimal) in the treatment of uncomplicated P. falciparum malaria in children betweem 6 and 144 months of age. P. falciparum malaria parasitemia was assessed by microscopy and rapid diagnostic test. Drugs were administered according to age for three days under supervision. The primary efficacy endpoint was a day 28 PCR-corrected parasitological cure., Results: A total of 182 patients were enrolled in the two treatment groups, Coartem (n = 101) and Larimal (n = 81), and tested after 28 days. In the intention-to-treat population, Coartem (n = 101) and Larimal (n = 81) had a PCR-corrected cure rate of 98% and 100% respectively, while in the per-protocol population, Coartem (n = 89) and Larimal (n = 71) both had a PCR-corrected cure rate of 100% at day 28. Although parasite and fever clearance time was faster in the Larimal group, no significant difference was observed between the two drugs. No serious adverse effects  were reported., Conclusion: Five years after being introduced in Nigeria, both Coartem and Larimal have been shown to be safe and highly effective in the treatment of uncomplicated P. falciparum malaria in children.

Background: Injury has been recognised as a preventable cause of morbidity and mortality in children. The aim of this study was to determine the aetiology, pattern and location of childhood injuries in north east Nigeria., Materials and Methods: This is a 3-year retrospective hospital-based descriptive study. The study included 114 children (77 boys, 37 girls; mean age 6.4 ± 3.2 years; range 2 months to 15 years) who were admitted for various injuries in the female/paediatric surgical ward from January 2007 to December 2009. Information obtained from their case notes included demographic data, mechanism of injury, location of injury, anatomical site of injury and outcome of treatment., Results: Records for 114 children (77 boys, 37 girls; mean age 6.2 years; range 2 months to 15 years) were available for analysis. The highest number of injuries occurred in the age group 6-10 years. Home was the most common location of injury among the age group 0-5 years while older children sustained most of their injuries outside the home on the street/highways. Burns from hot water was the most common injury among children aged 0-5 years while pedestrian accident accounted for the highest cause of injury among older children. Fall accounted for 20.2% of the injuries. The most common specific anatomic injury was head injury followed by limb fractures. Two mortalities were recorded (1.8%)., Conclusion: This study provided useful information on the characteristics of childhood injuries in our environment. There is the need for parents and children education about the risks of injury and preventive measures in addition to legislation and policy on environmental modifications and enforcements to significantly reduce childhood injury.

The volatile oils extracted from leaves of eight cultivars of Citrus sinensis (L) Osbeck were comprehensively analysed by a combination of GC and GC-MS. Fifty four constituents accounting for 82.3-98.2% were identified. Sabinene (20.9-49.1%), delta-3-carene (0.3-14.3%), (E)-beta-ocimene (4.4-12.6%), linalool (3.7-11.1%) and terpinen-4-ol (1.7-12.5%) were the major constituents that are common to all the volatile oils. In addition, a cluster analysis was carried out and indicated at least four different chemotypes for the C. sinensis cultivars.

Introduction: The definitive treatment of Hirschsprung's disease is removal of the aganglionic bowel by a pull-through surgery. In most cases this surgery is performed in infancy or the neonatal period as presentation in older children and adulthood is rare. Nevertheless, pull-through in this age group may be necessary and present peculiar challenges., Materials/methods: A prospective study of patients above 5 years with Hirschsprung's disease who presented at LUTH, Lagos between January 2007 and July 2010., Results: There were fourteen patients (10 males and 4 females). The median age was 9 years (range 5-31 years). All the patients presented with constipation and abdominal distension. Seven patients presented with intestinal obstruction necessitating colostomy. Thirteen patients had short segment Hirschsprung's disease limited to the rectosigmoid. The only exception had long segment disease with the transition zone located at the transverse colon. Ten patients (71.4%) had colostomy before definitive pull-through while four patients (28.6%) had primary pull-through procedure without a colostomy. The definitive pull-through procedure done in all the patients was Swenson's abdomino-perineal pull-through and all the patients had a 2-layered colo-anal anastomoses. Due to the rigid pelvis in these patients, as well as possible scarring, simple blunt dissection was difficult in these cases. The median length of follow up was 11 months (range 6-28 months). There was one case (7.1%) of mortality., Conclusion: Older patients with Hirschsprung's disease present with intestinal obstruction and poor nutritional status that may necessitate preoperative colostomy. Swenson's pull-through in them poses peculiar challenges of mobilization of bowel and achieving a reliable colo-anal anastomosis, however, outcome is comparable with surgery in younger children if these challenges are overcome., (Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)