Background: Circadian variation in blood pressure (BP) has been shown to determine cardiovascular events in people with chronic kidney diseases (CKDs). Studies aimed at elucidating the relationship between diurnal variation in BP and cardiovascular disease have yielded conflicting results, and very few of these studies have been conducted on CKD patients in Sub-Saharan Africa, hence the need for this study. Subjects and Methods: Eighty-five adult participants comprising 54 patients with CKD (36 males and 18 females) and 31 hypertensive patients (16 males and 15 females) free of CKD were recruited for 24 h ambulatory BP monitoring and cardiovascular risk factor assessment. Results: Patients with CKD had a higher mean clinic systolic BP (159.8 ± 28.6 vs. 147.9 ± 19.0 mmHg, P = 0.049) and reduced estimated glomerular filtration rate (19.2 ± 18.6 vs. 106.2 ± 30.6, P < 0.0001) when compared with hypertensives free of CKD. The mean 24 h ambulatory SBP (135.9 ± 28.5 vs. 120.3 ± 11.8 mmHg, P = 0.007), diastolic BP (82.6 ± 18.1 vs. 74.8 ± 9.0 mmHg, P = 0.034) and mean arterial pressure (100.9 ± 21.2 vs. 90.6 ± 10.2 mmHg, P = 0.018) were higher amongst CKD patients. Compared with hypertensive without CKD, daytime hypertension (58.9% vs. 21.4, P = 0.001), nocturnal hypertension (80.4% vs. 50.0%, P = 0.004) and non-dippers (92.0% vs. 73.1%, P = 0.026) were commoner in people with CKD. White coat effect was more common amongst hypertensives without CKD (74.2% vs. 38.0%, P = 0.002). The mean left atrial diameter and left ventricular mass index were higher in CKD group. Conclusion: This study highlights the high prevalence of varied phenotypes in circadian rhythm amongst CKD patients. Ambulatory blood pressure monitoring may be useful for early risk stratification of CKD patients. Large longitudinal study is needed to assess the prognostic implication of the findings.

Context: Brain Fag syndrome (BFS) is a culture-bound disorder that is quite common among Nigerian students. It is known to be associated with study difficulty, and in severe cases, discontinuation of education. Little is known about its pattern and predictors among secondary school (SS) students in Calabar. Aims: This study aims to determine the pattern and sociodemographic predictors of BFS among SS students in Calabar. Participants and Methods: Stratified sampling was used in this cross-sectional study to recruit 1091 students from ten SSs in Calabar metropolis. The students completed the Brain Fag Syndrome Scale and a sociodemographic questionnaire which were used in the survey. Data was analysed using SPSS software version 21. Results: The prevalence of BFS was 20.4%. Female gender, school type and local government of location, residence type, parental marital status and maternal educational status were found to have statistically significant relationships with the disorder (P ≤ 0.05). Significant predictors of BFS were female gender (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.14–2.09) and having parents who were 'not married' (OR = 1.8, 95% CI = 1.24–2.85). Conclusions: We conclude that BFS is highly prevalent amongst SS students in Calabar metropolis albeit at a relatively lower level compared to similar studies and is significantly predicted by female gender and having parents who are unmarried. We recommend that more research should be performed on this much-neglected psychopathology to elucidate it further, with consequent development of appropriate treatment modalities.

Purpose: Restoration of partial edentulous mouth may be done using a variety of treatment options. Removable partial denture (RPD) is commonly used because of its availability. RPDs from flexible resins unlike those from acrylic engage hard and soft tissue undercuts and feel more comfortable in the mouth. The aim of the study was to compare satisfaction with dentures made from these two types of materials. Materials and Methods: It was a quasi-experimental study among thirty patients at the Prosthetics Clinic, University College Hospital, Ibadan. Patients aged 16 years or more, requiring RPDs with one to three missing teeth in the anterior region of either the upper or lower arch participated. A modified semi-structured interviewer-administered questionnaire was used to collect data on sociodemographics and oral health variables. The level of satisfaction was assessed using a visual analogue scale. Data were analysed using descriptive and multivariate statistics at a significance level of P < 0.05. Results: The participants' ages ranged between 16 and 51 years, mean age was 33.8 ± 10.01 years. Male: female ratio was 1:1 and mean duration of edentulousness was 11.37 ± 10.52 years (median - 9.50). Most 28 (93.3%) subjects delayed replacement of their missing teeth; reasons were indifference 13 (43.4%), financial constraint 10 (33.3%), ignorance 4 (13.3%) and fear of aspiration 1 (3.3%). Overall, 21 (70.0%) participants were more satisfied with the flexible dentures, 6 (20.0%) with acrylic dentures while 3 (10.0%) were equally satisfied with both types of dentures (P = 0.04). Conclusion: Subjects were more satisfied with the flexible RPD than the acrylic resin RPD.

Background: Invasive candidiasis has been identified globally as a major cause of morbidity and mortality in neonatal intensive care units (NICU). Systemic candidiasis presents like bacterial sepsis and can involve multiple organs. Objective: The objective of this study was to determine the prevalence of Candida infection in a NICU at a tertiary hospital in Nigeria and to identify its associated risk factors. Materials and Methods: The study was a retrospective descriptive study of all cases of culture-proven invasive Candida infection (ICI) in neonates admitted to the NICU over a 4-year period. The study participants were identified from microbiology records of all neonates with a positive Candida culture. Medical records of identified neonates were also reviewed, and relevant information obtained. Results: Over the 4 years, 2712 newborns were admitted to the NICU. From these, 1182 various clinical samples were collected from babies with features of sepsis and processed in the medical microbiology laboratory. Twenty-seven (2.3%) of the cultures yielded Candida organisms; fifteen of the Candida cultures were from male infants with a male:female ratio of 1.3:1. Bloodstream infection was the most frequent ICI seen in preterm babies (seven [58.3%] out of 12 babies with ICI). Nearly, all (91.7%) affected preterm infants with ICI were <1500 g in weight. All were exposed to invasive procedures and broad-spectrum antibiotics. The case fatality rate among those with ICI was 18.5%. Conclusion: There was a significant prevalence of invasive candidiasis in high-risk newborns and the incidence increases with increased practices in risk factors such as invasive procedures and antibiotic use and lower gestational age babies with very low birth weight.

Background: Endotracheal intubation is an integral part of general anaesthesia in children, and the choice of induction agents and technique may affect the ease of intubation and thus the outcome of paediatric patients. We compared the ease of endotracheal intubation following sevoflurane and propofol-suxamethonium induction using Helbo–Hansen score. Patients and Methods: A prospective, randomized double-blinded comparative study conducted on sixty-six children (two groups of 33 each) between the ages of 3–10 years undergoing different elective surgeries. Group I received intravenous propofol and intravenous suxamethonium while Group II had inhalational induction with sevoflurane in 60% nitrous oxide and oxygen. Data including intubating conditions, time to tracheal intubation and haemodynamic changes were analysed using SPSS version 18, with statistical significance set at P < 0.05. Results: Using the Helbo–Hansen intubation score, the study reveals that 28 patients (85%) scored 4, 5 (15.2%) scored 5 and no patient scored 6 in Group I whereas 15 (45.5%) scored 4, 16 (48.5%) scored 5 and 2 (6.1%) scored 6 in Group II with P = 0.002. The mean time taken from induction to laryngoscopy was 91.27 ± 29.96 s in Group I and 219.09 ± 63.88 s in Group II (with P < 0.0001); mean time taken from laryngoscopy to completion of intubation was 29.03 ± 10.61 s and 28.09 ± 9.48 s which was not statistically significant with P = 0.71. Conclusion: Sevoflurane provides clinically acceptable intubating conditions and can be a suitable alternative to propofol-suxamethonium for endotracheal intubation in children. We recommend the use of sevoflurane to facilitate intubation in elective procedures in children.

Objective: Blood transfusion practice emphasises safety, efficacy and appropriate use. These require cost-effective programme management. This study focused on the cost of screening for transfusion transmissible infections (TTI). Methods: This was a 1 year (2016) analysis of screening in a hospital-based transfusion centre. The cost of screening all blood donors by ELISA was compared to the cost of serial screening starting from rapid kit, taking into account, the estimated cost of blood bags prevented from discard after ELISA screening (attributable cost). The cost of voluntary donor drive plus cost of ELISA screening was compared with the present cost of screening. Results: A total of 5591 donors were screened for HIV, hepatitis B and C using the rapid kit, 291 donors were deferred (5.2%). A total of 5300 units were further screened by ELISA. A total of 435 blood units (8.2%) were discarded due to TTI positivity. TTI positivity rate was 12.98%. Only 2.36% were voluntary donors and among these 9.1% were TTI positive. The attributable cost of serial screening was 55,653.5 USD while that of screening by ELISA only was 55,910 USD. The attributable cost of rapid screening for only hepatitis B and then ELISA was 53,313.9 USD taking into consideration that 187 blood units would be prevented from undue discard. Conclusions: This analysis demonstrated that with proper donor selection, rapid screening for hepatitis B virus only before ELISA screening is more cost-effective. This will also reduce the waiting time for donors and counselling if HIV positive.

Background: Sleep is a necessity; it is nourishing, refreshing and healing. The nursing profession is associated with busy and difficult work schedules, especially the running of shifts which has been associated with cardiovascular and metabolic complications. There is a dearth of local data on sleep disorders, especially among nurses. In this study, we evaluated the quality of sleep and the tendency of daytime sleepiness among nurses. Subjects and Methods: This study was cross-sectional in nature involving 100 nurses working with Federal Medical Centre Birnin Kebbi, Kebbi State; the study was carried out between October 2016 and February 2017. The Pittsburg Sleep Quality Index was used to determine poor sleepers; while the Epworth Sleepiness Scale (ESS) was adopted to determine the presence of tendency of daytime sleepiness; 0–7 was considered normal, 8–9 represented average tendency of daytime sleepiness, 10–15 represented excessive daytime sleepiness, while 16–24 represented daytime sleepiness requiring medical intervention. P < 0.05 was set as statistically significant. Results: There were 23 (23%) males and 77 (77%) females, with a male-to-female ratio of 0.3:1. The age range was 18–50 years, with a mean age of 31.4 ± 8.6 years. The ESS score ranged from 0.0–17.0, with a mean score of 7.3 ± 3.5; while the Pittsburg score ranged between 1 and 15, with a mean score of 5.7 ± 2.7, and 61% of the nurses had a poor sleep quality. There was unlikely tendency of excessive sleepiness across all the age groups, though this was not statistically significant (χ² = 7.258, P = 0.283), and poor sleep quality was most prevalent among the 25–40-year-old group but this observation was also not statistically significant (χ² = 2.259, df = 2, P = 0.334). Conclusion: Poor sleep quality is a problem among nurses, though less tendency to daytime sleepiness was observed in this report.

Background: Self-discharge by patients without completing their treatment is a problematic issue in healthcare and is strongly associated with readmission and poor treatment outcome. Patients and Methods: A descriptive study of the rate and reasons why patients with limb injuries took self-discharge against medical advice (DAMA) from our facility, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, a tertiary health institution between May 2011 and April 2014. Results: One hundred and thirty-one (16.2%) patients took DAMA out of 810 patients seen with limb injuries. Age ranges from 3 to 95 years with a mean of 36.31 ± 19.34 years. Road traffic crash accounted for 110 (84%) of the injuries. One hundred and sixteen (88.5%) had fractures and 9 (6.9%) had soft tissue injuries. Fifty-eight (44.3%) of the patients were referred cases, 128 (97.7%) signed DAMA form while 3 (2.3%) absconded from the hospital. Reasons for DAMA were mainly; belief more in traditional bone setters (TBSs) (36.6%); pressure from relations (22.9%) and high cost of hospital care (19.8%). One hundred and one (77.1%) of the patients volunteered that they were going to TBS for continued care. Conclusion: High percentage of patients DAMA from our facility and majority of them were in favour of unorthodox form of treatment.

Context: Progestogen-only injectable contraceptive is a long-lasting contraceptive given at interval of two or 3 months. It is effective, safe and convenient. Menstrual irregularity is a recognised side effect. Aims: This study aims to determine the acceptor prevalence and clinical experience of women using progestogen-only injectable contraceptive at Olabisi Onabanjo University Teaching Hospital, Sagamu. Methods: This was a retrospective study of new acceptors of progestogen-only injectable contraceptives between 1 January, 2010, and 31 December, 2014. Relevant information was retrieved from the family planning clinic records using a purpose-designed data capture sheet. Data analysis was done using IBM-SPSS windows version 21. Results: Out of a total of 623 new acceptors of contraceptives during the study period, 162 opted for progestogen-only injectable contraceptives giving an acceptor prevalence of 26%. The mean age of new acceptors was 32.69 ± 5.94 years. Majority 108 (66.7%) used depot medroxyprogesterone acetate. Child spacing was the most common indication for use. Ninety-seven clients (59.9%) had not used any previous contraceptive method. Menstrual irregularity was the most common side effect, occurring in 73 (45.1%) of the clients. Continuation rate after the fifth dose was 27.1%. No pregnancy complication was reported. Conclusions: Acceptor prevalence and continuation rate of progestogen-only injectable contraceptive are low. There is need for more enlightenment campaigns to encourage women to use this effective method of contraception.

Background: Dysphagia is assciated with numerous medical conditions including stroke, and there are wide variations in reported frequency of dysphagia in stroke survivors in the literature. Dysphagia has been shown to be an important risk factor for aspiration pneumonia and has profound impact on survivors. Aims: This study aims to determine the frequency of dysphagia in stroke survivors and its effects on short-term outcome. Methods: Consecutive patients hospitalised for first-ever acute stroke at Ahmadu Bello University Teaching Hospital Zaria, Nigeria, were prospectively enrolled from April 2015 to January 2017. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS). Water swallowing test was used to screen patients for the presence of dysphagia. This was followed by swallowing provocative test which was aimed at evaluating swallowing reflexes. All the patients were then followed up till day 30. Outcome measures applied were 30-day mortality and functional impairment on the Modified Rankin Scale. Results: Ninety-four patients (53 males and 41 females) with acute stroke were studied. Mean age of patients was 55.51 ± 15.7 years and 32 (34.4%) patients had dysphagia at presentation. Mean NIHSS score of patients with dysphagia was significantly higher than those without dysphagia. Aspiration pneumonia occurred more significantly in those with dysphagia. In multivariate logistic regression, only aspiration pneumonia was independently associated with 30-day mortality. Conclusion: The prevalence of dysphagia in this cohort of stroke patients was 34.4%, and the major independent determinant of 30-day mortality was development of aspiration pneumonia.

The intubating lightwand is a recommended airway management tool in patients with failed direct laryngoscopy or intubation; but the device is under-utilised. This study reports successful lightwand intubation in a cohort of 22 consecutive adult patients with difficult airway; who required endotracheal general anaesthesia, in the presence of limited management options. Patients underwent different procedures: tonsillectomy (2), pharyngeal biopsy (6), abdominal surgery (5), thoracoscopy (3) and maxillofacial surgery (6). All the patients had a difficult airway, reduced mouth opening, neck anomalies and airway scores of Mallampati 3 or 4. They were all intubated easily, promptly and safely with the lightwand. This study shows the utility of lightwand intubation in patients with difficult airway and limited airway management options. The study highlights that the lightwand is durable, portable, cost-effective, easy to use and easy to maintain; compared to other devices for difficult intubation.

Schwannoma is a benign tumour of Schwann cell origin. Although it commonly occurs in the head and neck region, its intraoral presentation is rare. Establishing a clinical diagnosis of schwannoma is often difficult due to its non-specific clinical features. Hence, histopathological telltale features of Antoni A and Antoni B areas are unexpected in most cases. Reported here is a case of intraoral schwannoma affecting a 17-year-old male who presented with a slow growing mass in the lower lip.