Open Access Original Research Article

Sources and Perceived Effects of Work-Related Stress among Nurses Working in Acute Care Units of University of Nigeria Teaching Hospital, Enugu - Nigeria

Justin Agorye Ingwu, Uwakmfon Asuquo Essien, Hope Opara, Ogbogu Chinenye, Chidinma Isreal Egbechi

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/38703

Introduction: Nursing is a highly stressful occupation especially for those working in the acute care unit. The aim of this study was to examine the sources and perceived effects of work-related stress among nurses working in acute care units of University of Nigeria Teaching Hospital, Enugu-Nigeria.

Methodology: This study utilized a descriptive cross-sectional design. The sample population encompassed 80 nurses working in acute care units (General intensive care unit, newborn intensive care unit, accident and emergency and children emergency room) of the hospital. Researcher constructed questionnaire was used as the research instrument.

Results: Result of the study showed that 40% of the respondents identified excessive workload as a source of stress, 35% stated caring with death and dying, 10% identified conflict with physicians while 11% choose inadequate preparation in cases of emergency. The most significant perceived effect of stress on physical health was identified as back pain 68.8%, headache 55%, and fatigue 28.7%. The most significant effect of stress on psychological health was 13.8% and 61.3% perceived physical exhaustion as the effect of stress on work behavior and 13% excessive sleeping.

Conclusion: It is widely accepted that nurses working in acute care settings are exposed to various stress sources from physical, psychological and social working environment.

Open Access Original Research Article

Predicting the Efficacy of Antivenoms against African Vipers and Elapids by Using Immunoblotting and Cytotoxicity Neutralisation Assays

Mila Nu Nu Htay, Nan Nitra Than, Htay Lwin, Mayada Aboelhassan Abdelmageed Hassanein, Wai Wai Myint

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2018/36687

Aim: Snakebite is an important public health problem especially in tropical and subtropical countries. Snake antivenom is the only specific treatment to save the lives. However, antivenoms are relatively expensive, have restricted efficacy to the species of snake whose venom was used to manufacture. Therefore, there is a compelling need to maximize the availability of antivenoms and to know the efficacy of different types of anitvenoms for various species of snakes.

Study Design:  In-vitro experimental study.

Place and Duration of Study: In the laboratory at the Medical Institution, between February to March 2014.

Methodology: Venom extracted from the viper and elapid snakes and four different antivenoms, manufactured from Africa, Australia and Asia were used in this study. Sodium dodecyl sulfate (SDS) gel was used to fractionate the venom protein. Immunoblotting allowed the transfer of fractionated proteins from the SDS gel to the nitrocellulose absorbent membrane, and then incubated it in antivenom to observe the binding of all different antivenoms to specific proteins in the venoms of different snakes. Immortalized African green monkey kidney cells (VERO) were used in cell cytotoxicity assay provided a functional measure of antibody efficacy to neutralise the pathological effects of venom in its native state.

Results: In immunoblotting assay, Ipser Afrique polyvalent and SAIMR antivenom exhibited the strong reactivity with elapid and viper venom proteins. In vitro cell cytotoxicity assay, Ipser Afrique polyvalent and SAIMR antivenoms were effective in neutralizing the toxicity of Echi ocellatus venom, meanwhile, Australian polyvalent and Banded Krait antivenoms were found to be ineffective for the same venom.

Conclusion: Antivenoms from different geographical areas were found to be ineffective against African snakes in this study. Therefore, local pilot trials should be done to ensure the safety and efficacy of antivenoms when introduce to new geographic area.

Open Access Original Research Article

Association between Germinal Matrix Hemorrhage and Perinatal Risk Factors in Preterm Neonates, in a Southwestern Nigerian Hospital

Adekunle Adefalujo, Adebola Yusuf, Imaralu John, Kofoworola Soyebi, Ireti Fajolu

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2018/38198

Aims: To determine the incidence of Germinal matrix hemorrhage (GMH) among preterm neonates and the associated perinatal risk factors.

Study Design: Prospective cross sectional study.

Place and Duration of Study: This study was carried out in the (two) neonatal units of Lagos University Teaching Hospital (LUTH), Idi-Araba, from May 2011 – April 2012.

Methodology: Transfontanelle Ultrasonography was done for 300 preterm neonates (136 male and 164 females) within the first 24 hrs of life and subsequently on the 2nd, 3rd, 4th and 7th days of life. Thereafter weekly until discharge or corrected 40 weeks. Sonographic findings and pertinent perinatal history from the case note of each neonate were documented using a proforma. Gestational age was determined from maternal dates (last menstrual period) and gestational assessment by Ballard score. Data were analyzed using IBM SPSS Statistic software, version 20.0 and Chi – square test with desired degree of accuracy at 0.05.

Results: GMH occurred in 95/300 neonates, giving an incidence of 31.7%. Anemia (33/50, p<0.001) and perinatal HIV exposure (100%, p<0.001) were the most significant risk factors. Antenatal corticosteroid administration had significant protective effect (p= 0.001). Gender however did not significantly determine the occurrence of GMH (p = 0.40).

Conclusion: The incidence of GMH in preterm neonates is higher than previously reported. Preventable perinatal risk factors are significant contributors. Antenatal steroid administration was found to be protective.

Open Access Original Research Article

Health Facility-Based Versus Community-Based Family Planning Education and Utilization of Modern Contraceptives in Rivers State, Nigeria

Adekunle Adefalujo, Adebola Yusuf, Imaralu John, Kofoworola Soyebi, Ireti Fajolu

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2018/38287

The use of modern contraceptives by rural women of childbearing age in Nigeria is low. The aim of this study is to compare a community-based family planning education and text message reminder with the conventional health-facility based approach to promotion of modern contraceptive use among rural women of childbearing age in Rivers State, Nigeria. 

Place and Duration of Study: This is a quasi-experimental before and after comparative study conducted in Etche (intervention group) and Tai (control group) local Government Areas (LGAs) in Rivers State Nigeria between August 2013 and January 2014. 

Methodology: A total of 196 and 184 rural women of child-bearing age, recruited into the intervention and control groups respectively through multi-stage sampling, were followed up for six months. Data was collected on socio-demographics, parity condition, awareness and sources of information on modern contraceptives, method used, problems encountered in the use of methods as well as reason for non-use and discontinuation of use. Data analyses was done with SPSS version 15. Level of statistical significance was set at P < 0.05.

Results: Respondents in both groups were similar in socio-economic characteristics except for age. All (n = 196, 100%) in the intervention group and nearly all (n =182, 98.9%) in the control, were aware of modern contraceptives. Respondents who consistently used a method increased from 37 (18.9%) to 75 (38.3%; P < 0.001) in the intervention group but decreased from 49 (26.6%) to 41 (22.2%; P = 0.33) in the control. Respondents in the intervention group were more likely to be late users (RR 1.67, 95% CI 0.98 – 2.83); less likely to discontinue use (RR 0.58; 95% CI 0.32 – 1.07).

Conclusion: Community-based family planning education and text message reminders is a more effective approach for promoting modern contraceptive use among rural women.  

Open Access Original Research Article

Chlamydia Infection-derived Exosomes Possess Immunomodulatory Properties Capable of Stimulating Dendritic Cell Maturation

Raedeen S. Russell, Khamia Ryans, Ming Bo Huang, Yusuf Omosun, Mahfuz Khan, Michael D. Powell, Joseph U. Igietseme, Francis O. Eko

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/JAMMR/2018/38821

Aims: The aim of this study was to characterize exosomes derived from Chlamydia muridarum-infected and normal healthy untreated mouse oviduct epithelial cells (MOEC) and evaluate their immunomodulatory properties.

Methodology: Exosomes were purified from C. muridarum-infected and uninfected MOEC and analyzed using the NanoSight nanoparticle tracking analysis system. The concentration of cytokines and chemokines associated with exosomes and secreted by exosome-activated bone marrow-derived dendritic cells (BMDCs) was assessed using the Bio-Plex cytokine assay kit in combination with the Bio-Plex Manager software. Also, the exosome-stimulated dendritic cell expression of co-stimulatory surface and major histocompatibility complex class II (MHC-II) molecules was assessed by FACS analysis.

Results: The results showed that the concentration of cytokines (IL-6, IL-10, IL-12, IFN-γ and TNF-α) and chemokines (KC (CXCL1), MCP-1 (CCL2), MIP-1α (CCL3), Rantes (CCL5) and Eotaxin (CCL11)) secreted by BMDCs pulsed with Chlamydia infection-derived exosomes (IDEX) was significantly higher (p < 0.05) than that secreted by BMDCs pulsed with uninfected control-derived exosomes (CDEX). Furthermore, exosomes purified from Chlamydia-infected MOEC significantly upregulated (p < 0.05) the dendritic cell expression of CD86 and MHC-II, molecules associated with DC activation and maturation, compared to those from uninfected cells.

Conclusion: The results indicate that Chlamydia IDEX possess immunomodulatory properties capable of stimulating dendritic cell activation and maturation. Further studies will delineate their potential use as immunomodulators or as vaccine delivery vehicles.

Open Access Original Research Article

A Comparative Clinical Trial of Efonidipine and Amlodipine in Management of Stage-I Hypertension: A Randomized, Double-Blind Study in Indian Population

Bhupesh Dewan, Vaidehi Wani

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2018/38509

Aims: The present clinical study was conducted to establish non-inferiority of efonidipine hydrochloride ethanolate (efonidipine) as compared to amlodipine besylate (amlodipine) in the management of Stage-I hypertension.

Study Design:  The study was a prospective, cohort, double-blind, double-dummy, randomized phase-III clinical trial

Place and Duration of Study: Nine geographically distributed sites across India were involved in the clinical trial between January 2015 to June 2016.

Background: The use of conventional L-type CCBs is often limited due to associated side effects. Efonidipine, a dual T- and L-type Ca2+ channel blocker has been proven to exhibit antihypertensive effect along with renoprotective actions with minimum systemic side effects. The present clinical study was conducted to evaluate the safety and efficacy of efonidipine for the first time in Indian patients with Stage-I hypertension.

Methodology: The present phase-III clinical trial was a double-blind, double-dummy, multi-center, and parallel group study conducted on the Indian population. A total of 200 patients were randomized to receive either efonidipine 40 mg (n=95) or amlodipine 5 mg (n=105) once daily for 28 days. The patients were evaluated for changes in the systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate.

Results: Efonidipine reduced SBP by 18.2 ± 12.2 mmHg, DBP by 10.7 ± 7.0 mmHg and heart rate was diminished by 8.1 ± 8.3 bpm while amlodipine reduced SBP by 19.2 ± 11.8 mmHg, DBP by 10.2 ± 7.7 mmHg and heart rate by 7.2 ± 9.9 bpm.

Conclusion: Efonidipine was concluded to be non-inferior to amlodipine in the reduction of SBD, DBP, and heart rate and was found to be comparable to amlodipine in the management of hypertension and its safety profile.

Clinical Trial Registration: The trial was registered with the Clinical Trial Registry of India; Reg. No: CTRI/2015/01/005359; Available at:

http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=7747&EncHid=&userName=CTRI/2015/01/005359

Open Access Original Research Article

Cognizance of Undergraduate Students toward Periodontal Ligament Injection in Exodontia

Suzan Salem, Arwa Namnakani, Islam Saad

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/38620

Aims: This study was aimed to develop a framework based on the existing knowledge among interns and dental students of their awareness of anesthesia technique which may help improve the treatment services provided to the community.

Study Design: Randomized clinical trial.

Place and Duration of Study: College of Dentistry, Taibah University, Madinah, Saudi Arabia between March 2017 and September 2017.

Methodology: The knowledge of Periodontal ligament (PDL) injection as a substitute technique for inferior alveolar nerve block (IANB) used by interns and dental students when performing tooth extraction. This was investigated using a questionnaire consisting of 10 questions and was distributed among 4th, 5th year students and interns at the college of dentistry, Taibah University, Saudi Arabia. Survey participants were asked about commonly administered injection techniques for extraction, awareness of periodontal ligament injection, periodontal injection technique, its point of entry, patient response, its effectiveness and the most common indication.

Statistical software SPSS® for mac .20, Chicago, IL, USA was used for statistical analysis.

Results: Injection technique commonly used for tooth extraction was 58.2%, 35.8% and 6% for nerve block, infiltration and PDL injection 6% respectively, significant difference at P- value (P≤0.05) was found between different academic level. Awareness of the PDL injection technique was 76.1% while 23.9% wasn’t aware, significant difference at P- value (P≤0.05) was found between different academic levels. Points of entry of PDL injection was 74.6%, 19.4% and 6% for gingival sulcus, attached gingiva and alveolar mucosa respectively, significant difference at P- value (P≤0.05) was found between different academic level. Participants using PDL injection for extraction and endodontic treatment was 44% while 56% not using it, significant difference at P- value (P≤0.05) was found between different academic levels. Patient response for periodontal injection was good for 50.7% of participants, significant difference at P- value (P≤0.05) was found between different academic level.

Conclusion: Most students know about PDL injection, but they only used it when routine IANB fails, they are also familiar with the technique, but need to increase their knowledge regarding indications and limitations of PDL injection.