Search

Background: Good breastfeeding technique is important in ensuring adequate milk delivery and preventing breastfeeding problems. Exclusive breastfeeding rate is quite low, and requisite skills regarding proper positioning and attachment of an infant while breastfeeding appears lacking among mothers in Nigeria. This study was undertaken to assess breastfeeding techniques of mothers attending the well-child clinics of two tertiary hospitals in southeast Nigeria. Materials and Methods: This cross-sectional descriptive study of 396 mother and child pairs who attend the well child clinics of two tertiary hospitals in Enugu (Enugu state University Teaching Hospital and University of Nigeria Teaching Hospital) between September 2018 and February 2019. An interviewer administered, well-structured pro forma was used to collect data while mothers were observed closely as they breastfed and scored using the World Health Organization criteria. Data were analyzed using SPSS version 22. Results: Most of the mothers studied (357; 90.2%) attended ante-natal care, and 365 (92.2%) of the deliveries were assisted by a health worker. Only 194 (49%) of mothers practiced good breastfeeding techniques. Maternal age (20–30 years) (P < 0.001, odds ratio [OR] 0.464), attendance to antenatal clinic (P < 0.001; OR 8.336), health education and demonstration on breastfeeding techniques before and after delivery (P = 0.001) and maternal level of education (χ2 = 13.173, P = 0.001) but not parity (P = 0.386; OR 1.192) were significantly associated with good breastfeeding techniques. Conclusion: There are suboptimal breastfeeding techniques among mothers. Increased awareness creation and regular demonstration of breastfeeding techniques are needed.

No Abstract.

No Abstract.

Background:: Carbamazepine has been used in the treatment of bipolar disorder, both in acute mania and maintenance therapy, particularly in developing countries. Not only its interaction with various drugs and auto-inducer nature, but the narrow therapeutic range of carbamazepine also makes monitoring necessary to guarantee the adequacy of its safety and therapeutic concentration. To date, the most common biological specimen used for therapeutic drug monitoring (TDM) purposes is still plasma, but saliva can become an alternative biological matrix since its level in saliva strongly correlates with carbamazepine plasma concentration. Objective:: This study validated the bioanalytical method parameters used for carbamazepine in spiked-saliva in accordance with the Food and Drug Administration (FDA) criteria in the Guidance for Industry Bioanalytical Method Validation. Methods: HPLC-UV detector was employed at 285 nm λ with methanol: water: glacial acetic acid (65:34:1) as the mobile phase and C8 as the stationary phase (4.6x150 mm; 5 μm). Results:: The linearity test in a range of 0.0 - 5 μg/mL carbamazepine concentration resulted in a correlation coefficient of 0.999 with 0.20 μg/mL LoD, 0.30 μg/mL LLoQ, and 0.61 μg/mL LoQ. The coefficient of variation and 0iff in the selectivity, accuracy, and precision parameters remained below 20%, indicating fulfillment of the criteria for a bioanalytical method, while the average % recovery was more than 90%. Conclusion:: The currently-developed bioanalytical method has fulfilled the stipulated validation criteria to be used for determining carbamazepine concentration in spiked-saliva as an alternative method for relative bioequivalence studies or TDM application in a clinical setting.

Uchenna Ekwochi,1 DI Chidiebere Osuorah,2 Samuel A Ohayi,1 Anthony C Nevo,1 Ikenna K Ndu,1 Stanley K Onah31College of Medicine, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria; 2Child Survival Unit, Medical Research Council, The Gambia Unit, Banjul, Gambia; 3College of Health Sciences, Nnamdi Azikiwe University Awka, Awka, Anambra State, NigeriaCorrespondence: DI Chidiebere OsuorahChild Survival Unit, Medical Research Council UK, The Gambia Unit, 78 Atlantic Boulevard, Fajara, GambiaEmail chidi.osuorah@yahoo.comBackground: Medical education is considered one of the toughest college degrees to acquire. Exploring the factors that determine good academic performance in medical school will help in the planning of curriculum and assist students to navigate through medical school more effectively.Methods: This cross-sectional and descriptive study enrolled 145 second year clinical students (500 level) of the Enugu State University of Science and Technology in south-east Nigeria using purposive and convenient sampling method. It assessed factors that predicted good academic performances in surveyed students.Results: Medical students without membership in any campus group, those that receive(s) less than ten thousand naira (≈US$27) every month as upkeep allowance, those admitted through the University Matriculation Examination, and students who visit their families on a weekly basis were more likely to have better academic performances than those in corresponding categories. Of these significant predictors of good academic performance, mode of admission into medical school (Rs=−0.310 P=0.001) and monthly allowance students got for upkeep (Rs=−0.281 P=0.001) had the strongest correlation with good academic performances.Conclusion: Our study identified factors that correlate with academic performances among medical students. We propose frequent appraisal of these factors and support system that will help improve performance in these students.Keywords: medical student, academic performances, medical school, Enugu

Samuel N Uwaezuoke,1 Ikenna K Ndu,2 Ngozi R Mbanefo11Pediatric Nephrology Firm, Department of Pediatrics, College of Medicine, University of Nigeria Nsukka/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, NigeriaIntroduction: The prevalence rates of the common histopathologic subtypes of childhood nephrotic syndrome associated with steroid resistance appear to be changing globally. In Sub Saharan Africa (SSA), the trend is similar over the past few decades.Aim: This systematic review aims to determine the current prevalence rates of the histopathologic subtypes associated with childhood steroid-resistant nephrotic syndrome (SRNS) in SSA.Methods: A search of the PubMed, Google and African Journals Online databases was conducted from January to December 2018 using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow-chart to identify relevant articles which met the aim of the systematic review. A qualitative synthesis and descriptive analysis of the extracted data were then conducted. The mean values for the prevalence rates of the reported histopathologic subtypes were calculated. A meta-analysis was not done due to few numbers of studies reviewed. The review is registered with PROSPERO, number CRD42018111916.Results: In the West African sub-region, the currently reported histopathologic subtypes associated with childhood nephrotic syndrome are focal segmental glomerulosclerosis (FSGS), minimal-change nephropathy (MCN), membrano-proliferative glomerulonephritis (MPGN), membranous nephropathy (MN) and mesangial proliferative glomerulonephritis (MesPGN). The picture is the same in South Africa. More importantly, the predominant histopathologic lesions associated with steroid resistance are FSGS (West Africa) and MCN/FSGS (South Africa), with mean prevalence rates of 57.2% and 36.1% respectively.Conclusion: The prevalence of FSGS is currently high in childhood nephrotic syndrome in SSA. This histopathologic subtype remains the commonest lesion associated with SRNS in this part of the globe.Keywords: steroid-resistant nephrotic syndrome, children, histopathologic subtypes, focal segmental glomerulosclerosis, prevalence, Sub-Saharan Africa

Samuel N Uwaezuoke,1 Adaeze C Ayuk,1 Ikenna K Ndu,2 Chizoma I Eneh,2 Ngozi R Mbanefo,1 Osita U Ezenwosu1 1Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: This narrative review aims to highlight the current paradigm on pain management in sickle cell vaso-occlusive crisis. It specifically examines the pathophysiologic mechanisms of sickle cell pain as well as the pharmacologic and nonpharmacologic methods of pain management. Recurrent painful episodes constitute the major morbidity in sickle cell disease (SCD). While adolescents and young adults experience mostly acute episodic nociceptive pain, it is now recognized that a significant number of adult patients develop chronic neuropathic and centralized pain. In fact, current evidence points to an age-dependent increase in the frequency of SCD patients with chronic pain.Management of disease-related pain should be based on its pathophysiologic mechanisms instead of using recommendations from other non-SCD pain syndromes. Pain management in vaso-occlusive crisis is complex and requires multiple interventions such as pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment involves the use of non-opioid and opioid analgesics, and adjuvants – either singly or in combination – depending on the severity of pain. The basic approach is to treat SCD pain symptomatically with escalating doses of non-opioid and opioid analgesics. Given the moderate-to-severe nature of the pain usually experienced in this form of SCD crisis, opioids form the bedrock of pharmacologic treatment. Multimodal analgesia and structured, individualized analgesic regimen appear more effective in achieving better treatment outcomes. Although the current evidence is still limited on the supportive role of cognitive behavioral therapy in pain management, this nonpharmacologic approach is reportedly effective, but needs further exploration as a possible adjunct in analgesia. Keywords: sickle cell pain, nociceptive pain, non-opioids, opioids, multimodal analgesia, cognitive behavioral therapy

Samuel N Uwaezuoke,1 Joy N Eze,1 Adaeze C Ayuk,1 Ikenna K Ndu2 1Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla Enugu, Nigeria; 2Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: Besides their fundamental role in transfusion medicine, ABO and other histo-blood group antigens are associated with the pathogenesis of some human diseases such as malignancy and thrombosis. Reports also show a possible relationship with the risk of asthma and other forms of respiratory atopy. This paper aims to critically review the current evidence linking ABO histo-blood group with the risk of respiratory atopy in children and adults. A literature search was conducted with PubMed to gather baseline data about this relationship. The search extended to studies published within the past 45 years. First, the molecular mechanism underpinning the role of ABO antigenic system in human diseases comprises a fascinating relationship with von Willebrand factor and several pro-inflammatory and adhesion molecules. Second, specific blood group types vary with asthma phenotypes; severe asthma is associated with B phenotype, while mild and moderate asthma is associated with O and A phenotypes. Third, O phenotype has been linked to allergic rhinitis but only in males. Furthermore, asthma risk is related to O/Lewis negative/secretor phenotypes, while a significant relationship has also been established with B phenotype but not with A and O phenotypes. However, one study failed to establish a significant relationship with any of the ABO blood group antigens. In conclusion, there is no unanimity on the specific histo-blood groups linked to respiratory atopy risk, although asthma phenotypes are associated with specific blood groups. Despite the prospect that this relationship holds for the use of blood-group typing in evaluating respiratory atopy risk in children, more evidence-based studies are still required for its validation. Keywords: blood-group phenotypes, asthma phenotypes, B phenotype, von Willebrand factor, asthma risk, blood-group typing

Objectives: This study aims to assess the susceptibility of depression among clinical students from two medical schools from South East Nigeria, using a screening test questionnaire.Methods: A total of 352 clinical medical students from two universities were enrolled by simple random sampling. A pretested self‑administered depression questionnaire was used to evaluate degrees of depression among the participants.Result: Out of the 352 students studied, 14 (4%) of the students are susceptible to moderate to severe depression while none are susceptible to mild depression.Among the students, gender and age were not significantly associated with depression (χ2 = 2.896; P = 0.089). Socioeconomic class of the students was not significantly associated with depression (χ2 = 2.186; P = 0.335).Conclusion: A relatively low number of medical students are susceptible to depression. Depression among medical students is unaffected by gender, age, and socioeconomic class.Keywords: Depression, depression questionnaire, medical student, Nigeria

Background: The relationship between food preference in early childhood and prenatal exposure to flavor in the amniotic fluid is well documented. Although its association with flavor transmission in the breast milk has also been noted, it is poorly reported in this country. Objective: The present study aims to determine the relationship between mothers’ dietary exposure during exclusive breastfeeding and food preference in their preschool-aged children. Methods: Two hundred and twenty (220) mother-child dyads who met the study criteria were enrolled. A pre-tested, structured questionnaire was administered to the mothers. The relationship between maternal consumption of flourbased snacks and staple foods during exclusive breastfeeding and the child’s preference for these foods was determined using risk estimates. After controlling for potential confounders, logistic regression was used for multivariate analysis. Statistical significance was determined at p < 0.05 and all the risk estimates were presented as odds ratios (OR) at 95% confidence intervals (CI). Results: The relationship between daily maternal exposure to staple foods during exclusive breastfeeding and the children’s preference for this variety of food was not statistically significant (p = 0.847, OR= 1.083, 95% CI = 0.481- 2.437). However, the children’s preference for flour-based snacks was significantly related to weekly or fourth-nightly maternal exposure to similar diet during exclusive breast feeding (p = 0.035, OR = 2.405, 95% C.I = 1.064 - 5.435). Conclusion: Transmission of flavor in the breast milk may contribute in shaping children’s feeding behavior early in life

Background: Paediatric abdominal surgical emergencies (PASE) constitute a significant workload of the paediatric surgeon. The objective of this study was to characterize the pattern of PASE in a tertiary hospital in Enugu and determine any change in pattern and outcome. Methodology: This was a retrospective study of children aged 1 day to 16 years who presented with abdominal surgical emergencies to Enugu State University Teaching Hospital (ESUTH), Enugu. Result: There were 152 patients recruited for the study. There were 122 males and 30 females. The mean age at presentation was 6 years while the mean duration of symptoms before presentation to the hospital was 3.5 days. Thirty eight (25%) patients presented within 48 hours of the onset of their symptoms while 114 patients (75%) presented after 48 hours. The emergencies were intussusception 56 (36.8%), typhoid intestinal perforation 30 (19.7%), obstructed hernia 20 (13.2%), appendicitis 17 (11.2%), abdominal trauma 10 (6.6%), neonatal intestinal obstruction 6 (4%), ruptured appendix 6 (3.9%), Hirschsprung’s disease 4 (2.6%), adhesive bowel obstruction 2 (1.3%), and Gastroschisis 1 (0.7%). The mean hospital stay was 6.7 days. Thirty four patients (22.4%) who had surgery developed post-operative complication. The most common complication was surgical site infection and this occurred most in patients who had typhoid intestinal perforation (P = 0.017). There were 12 (7.9%) deaths. Conclusion: In this series, intussusception was the most common paediatric abdominal surgical emergency seen in Enugu unlike in the past when it used to be typhoid intestinal perforation. Mortality was less in the current study. This illustrates a change in pattern and outcome.