Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome.

Objective: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS). Materials and methods: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student\u2019s t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant. Results: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values. Conclusion: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome

The effect of culture on Corporate Governance Practices in Nigeria

This study focuses on the effect of culture on the application of corporate governance practices in Nigeria. Corporate governance has been receiving serious attention in emerging markets over the past two decades. But relatively little attention has been given to the study on corporate governance in a country study. The current situations in Nigerian public and private sectors such as the corporate scandal resulting from Lever Brothers Nigeria plc, Siemens, Shell, Halliburton, and Cadbury Nigeria plc, have shown that the issue of fraud, corruption, and corporate scandals cannot be overlooked. Most top management, as this study argues, bring in beliefs acquired from their early childhood into their senior management roles and responsibilities. This study adopts a grounded theory and reports on the effect of culture on the implementation of corporate governance in Nigeria. Based on the interview with 32 staffs, this study identifies the effect of culture that shapes corporate governance and they include abuse of power by top management, weak legal framework, poor recruitment and ineffective control. Although having efficient corporate governance is worth pursuing, this depends on the power of top management, the strength of internal control procedures and the legal framework put in place by management

Awareness under Anaesthesia: A review of patients following General Anaesthesia at a Tertiary Hospital in Nigeria

Background: Awareness and recall of surgical events under general anaesthesia is an uncommon adverse effect that may result in psychological distress for the patient. This prospective review of cases was performed to evaluate the incidence of awareness and recall during general anaesthesia in a surgical population at the University College Hospital, Ibadan.Patients and Methods: A prospective audit was conducted over a period of 10 months using open ended questionnaire administered within 24 – 36 hours postoperatively to patients who had surgical procedures under general anaesthesia. The anaesthetic record of each patient that had awareness and recall was reviewed to search for data that might explain the awareness episode.Results: A total of 1,185 patients were visited in the postoperative period. Nine hundred and fifty-five patients (80.6%) had general anaesthesia while 230 patients (19.4%) had other forms of anaesthesia (regional anaesthesia or conscious sedation). Of the 955 patients (479 males and 476 females) that had general anaesthesia, 7 (5 females and 2 males) patients reported occurrence of awareness during the operation with recall of intra-operative events, the incidence of awareness was 0.7%. Identified risk factors in patients who reported awareness include lack of amnesic premedication, light general anaesthesia as a result of sub-optimal doses of hypnotic agents and failure to administer supplemental doses of analgesic intra-operatively.Conclusion: The incidence of awareness with recall in this prospective review was 0.7%, light anaesthesia being the major predisposing factor. Use of amnesic premedicants, monitoring of end tidal volatile agent concentration and intraoperative supplementation of analgesia may reduce the occurrence of awareness under general anaesthesia

Anesthetic and surgical predictors of treatment outcome in re-do craniotomy

Introduction: Craniotomy is a neurosurgical operation done to remove brain tumor, repair vascular lesion, and relieve intracranial pressure. Complications can arise which may necessitate re-do craniotomy. The study is planned to find out the relationship between variables such as age, American Society of Anaesthesiologist (ASA), Glasgow coma score (GCS), frequency of re-do craniotomy, and surgical outcome of re-do craniotomy. Materials and Methods: This is a retrospective study of all the patients who had re-do craniotomy over a 4-year period. The data that were collected included age, sex, ASA classification, indication for re-do craniotomy, GCS, frequency of re-do craniotomy, postoperative complications, and outcome. Results: Twenty-five patients had indication for re-do craniotomy within the study period. Forty percent were male and 60% were female, and their mean age was 38.56 ± 17.38 years. The indications for re-do craniotomy were removal of residual tumor, evacuation of clot, and cerebrospinal fluid leakage. Seventy-six percent had good outcome, while 24% had poor outcome. Outcome was good for patients who had re-do craniotomy done once, while poor outcome was for patients with second and third craniotomies. Ninety percent of patients with ASA 2 had good outcome, while 9.1% had poor outcome; but 64.3% had good outcome with ASA 3, while 37.7% had poor outcome with a P-value of 0.18. Seventy-five percent had poor outcome in patients with GCS of less than 9, while 25% had good outcome; but 14.3% had poor outcome in patients with GCS above 9, while 85.7% had good outcome with a P-value of 0.031. Conclusions: Increasing frequency of re-do craniotomy and lower GCS were major factors affecting outcome in re-do craniotomy in our center. The outcome of these patients is valuable in the management of other patients with re-do craniotomy in future

Epidemiology of bacteria colonization and ICU-acquired infection in a Nigerian Tertiary hospital

Background: Health care associated infection (HCAI) or Hospital acquired infection is associated with significant morbidity, mortality and cost. The incidence is about 6% and disproportionately higher in critically ill patients who may have been immune-compromised with many invasive procedures already performed. Prevention of HCAI and appropriate management of patients in the intensive care unit (ICU) requires knowledge on the pattern of microbial colonization and infections. The aim of this preliminary study was to provide current data on the pattern of ICU acquired infections in our hospital.Patients and Methods: It was a cross sectional study of patients admitted into the ICU who were expected to stay longer than 48hrs between July 2011 and September 2012. Urine, blood, and tracheal aspirate were collected on days 1, 3 and 5 for microbiological studies. All patients involved in the study had urethral catheter in-situ and received mechanical ventilation in the ICU.Results: Fifty-nine patients were recruited into the study. The mean age of the patients was 30.08 + 19.9yr; while the reasons for admissions were respiratory failure (59.3%), cardiovascular instability, trauma and neurological diseases. About 30% of the samples taken from the study sites on arrival in the ICU had positive culture yields. Organisms cultured included Klebsiella oxytoca, Staphylococcus aureus, and Pseudomonas aeruginosa. The urinary tract had the highest number of isolated organisms- 9(60%), followed by equal number of isolated organisms-3(20%) in the blood and respiratory tract. Eleven (73.3%) of the organisms isolated were Gram-negative bacteria, and 4 (26.7%) were Gram-positive cocci. The commonest bacteria isolates were Staphylococcus aureus (4/26.7%) and Klebsiella oxytoca (4/ 26.7%). A total of 15 ICU- acquired infections were detected in 9 of 59 patients.Conclusion: The HCIA infection rate was 15%, and urinary tract infections (UTI) was the commonest hospital acquired infection in our ICU. Klebsiella oxytoca and Staphylococcus aureus were the commonest organisms.Key words: Health care associated infections (HCAI), Hospital acquired infections, Nosocomial infection

A Comparative Study between AFB Smear Microscopy (Ziehl-Nelsen) and Gene-Expert Technique in the Diagnosis of Tuberculosis

611 samples were collected and tested for AFB using the Zeihl-Neelsen technique. Of the 611 samples tested, 525 were negative with Ziehl-Neelsen AFB smear microscopy. The 525 negative samples were tested using the genexpert technique. 53 out of the 525 samples were positive with genexpert with a percentage positivity rate of 10.1%. The data analysis was done using the student’s t-test. There was a significant difference between the sensitivity of Ziehl-neelsen technique when compared with genexpert technique (t= 3.32; p&lt; 0.05). Hence, there was a demonstrated increase in laboratory based TB detection using Xpert MTB/Rif compared to smear microscopy (ziehl-neelsen).</jats:p