Hyperprolactinaemia frequently causes secondary hypogonadism through central suppression of gonadotropin secretion. Macroprolactinomas (> 1 cm diameter) are more common in males and may additionally cause more generalised hypopituitarism. Recovery of the thyrotropic and/or corticotropic axes is well described following selective adenomectomy, but remains poorly defined in relation to medical (dopamine-agonist) therapy of macroprolactinomas. We therefore performed a retrospective examination of case records of male patients who had received medical therapy alone for macroprolactinoma between 1980-2001 (n = 35) and in whom tumor shrinkage was documented by interval pituitary imaging (reported throughout by a single neuroradiologist). Mean prolactin level at baseline was 59,932 mU/L (median 31,400; range 3,215-332,000); mean period of follow up was 4.2 years (median 2.6; range: 1.0-15). Defects of the following axes were evident at diagnosis: LH/FSH-testosterone (n = 27; 77%), TSH-T4 (n = 14; 41%-not including one case with pre-existing 1 degress hypothyroidism), ACTH-cortisol (n = 8; 23%). Overall, 14 men (40%) were deficient in 1 axis, seven (20%) in 2 axes and seven (20%) in 3 axes. Growth hormone secretory status was not systematically evaluated. In all but 6 patients, prolactin levels fell to normal or near-normal levels (mean 764 mU/L; median 260; range: < 10-4,833). Of the patients in whom adequate reassessment had been performed, thyrotroph function recovered in 4/9, corticotroph function in 4/6 and gonadotroph function in 16/26 cases. In four cases (11%) previously described, development of visual impairment as a result of the chiasmal traction syndrome necessitated a dose reduction in medical therapy to allow a degree of controlled tumor re-expansion. The prevalence at diagnosis of TSH and ACTH deficiency in men with macroprolactinomas was 41% and 23%, respectively. Among eight patients with insufficiency of TSH and/or ACTH secretion who underwent complete interval reassessment over several years of treatment, recovery of at least one axis occurred in six cases (75%). This study highlights the importance of screening ACTH- and/or TSH-deficient men during dopamine agonist therapy in order to identify cases where hypopituitarism has resolved.

Postpartum depression (PPD) is a common mental health challenge in resource-constrained sub-Saharan Africa (SSA). Characterizing its correlates will aid prediction, early detection, and pre-emptive interventions. This review aimed to systematically synthesize and stratify PPD correlates in sub-Saharan Africa. The review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-Analyses. We included studies that reported the correlates of PPD in SSA. We searched PubMed, Medline, CINAHL, Academic Search Complete, and PsycINFO for relevant peer-reviewed literature. The correlates of PPD constituted the primary outcome. A random effect model was fitted to estimate the pooled correlation coefficient per correlate. The clinical relevance of correlates was stratified based on strength of correlation (r) and recurrence (f). The mean age of the participants was 27.0 ± 6.0 years, and 68.6% of participants had completed at least secondary education. The correlates of PPD in SSA were intimate partner violence (IPV) ((risk weight (rw) = 2.8; r = 0.212 (confidence interval (CI): 0.11–0.31), poor social support (PSS) (rw = 1.9; r = 0.250 (0.133–0.361)), unwanted pregnancy (UP) (rw = 1.6; r = 0.279 (CI: 0.14–0.41); I2 = 95.89), and maternal age (MA) (rw = 0.96; r = 0.27 (CI: 0.154–0.37)), among others. A cumulative risk weight of ⩾0.95 was predictive of PPD and marks the critical point at which preemptive interventions should be instituted. The stratification of risk PPD factors and computation of risk stability index are useful in identifying the clinical significant risk factors. The provision of critical risk point will simplify early detection thus facilitating cost-effectiveness. Of the correlates of PPD in SSA, IPV, PSS, UP, and MA are the most important. Targeted screening and pre-emptive interventions for women with high risk weight may be a reasonable strategy both in the short and long term.

Successful treatment of HIV with anti-retroviral therapy (ART) is resulting in more people living with HIV-associated neurocognitive disorder (HAND). In sub-Saharan Africa, this calls for strategic planning and judicious allocation of scarce resources, which requires an accurate estimate of the prevalence of HAND. Estimates of the prevalence of HAND in sub-Saharan Africa vary greatly, between 18.8% and 88.3%. This variability may be explained by factors such as different diagnostic approach, neuromedical examination, ART status, sampling method, substance abuse, assessors’ qualification, depression and outcome measure. Different methods of diagnosing HAND, different outcome measures and non-random sampling techniques make it almost impossible to accurately estimate the prevalence of HAND in sub- Saharan Africa, often resulting in overestimation of the burden of disease. Consumers of health research should consider certain study characteristics and exercise appropriate caution when interpreting burden of disease in sub-Saharan Africa, especially when pursuing policy shift. Underestimating the prevalence of HAND will certainly affect the capacity and speed of containment, while overestimating will draw unnecessary attention and result in the misallocation of scarce resources.

Background: Patient care in Nigeria is essentially an interprofessional teamwork. The functionality of the team may have substantial implications on the quality of patient care as well as the professional satisfaction of individual professionals in the health team. This study was designed to identity if interprofessional conflicts existed in health teams in health institutions in southeast Nigeria, and to explore their nature, course, identify the extant resolution mechanisms and to start to identify and document feasible mechanisms to mitigate the conflicts. The aim is to enhance the functionality of health teams for an overall better patient care outcome.Method: An online questionnaire survey collected data from 58 health healthcare professionals in four healthcare settings in the southeast of Nigeria. Quantitative and qualitative analyses were conducted resulting in seven central themes of conflict. The paper adopted narrative qualitative survey tools to survey a cohort of healthcare professionals who have practiced for varying periods. This study investigated the existence, or otherwise, and nature of the conflicts within health teams, probes the most at conflict as well as approaches being used in conflict resolution.Results: Many institutional conflicts exist among the healthcare teams. There are several conflict resolutions approaches that are being employed to resolve the conflicts. Most resolutions are simply the avoidance approach. Many of the conflicts potentially affect patient care outcomes but these are issues that could be resolved on a permanent to semi-permanent basis at local levels whilst others are broader institutional issues that will require external fixes. Discussion: There is a need to improve on the team process for healthcare professional early and systematically. Key or essential steps for doing this based on the importance of continued attentions to better patient care approaches are provided in this paper.

No abstract

Background: The novel coronavirus disease (COVID-19) outbreak has halted activities throughout the globe because of its rapid spread. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a β-coronavirus first detected in China. SARS-CoV-2 has been implicated to be transmitted via direct contact, fomite, respiratory droplets, and possibly aerosol. The spread of the disease is complicated due to the slow onset of symptoms and asymptomatic infected patients. Methods: This narrative communication summarizes the recent researches sourced using sensitive search strategies to identify COVID-19 current perspectives on the control, prevention, and therapeutic promise. Result: Several strategies and multiple control measures have been implemented around the globe to contain COVID-19. Considering the exponential spread of the pandemic, several scientists and physicians have been racing to discover possible therapeutics and vaccines for COVID-19. There are clinical trials to investigate the vaccine designed to protect against the infection and also to substantiate the claim made for BCG protection against COVID-19. Although, there is currently no universally approved medication to treat SARS-CoV-2, there have been random reports of existing medications ameliorating the infection, and these regimens are still under clinical trial. There is also the potential therapeutic prospect of rhinothermy to fight SARS-CoV-2 judging from its success in fighting upper respiratory tract viral infection. Conclusion: The information provided in this communication gives a reliable intellectual grounding regarding the current perspective on COVID-19 control, progress made in the development of vaccines and therapeutic regimen, and where future research in this area should be focused. Key words: COVID-19; SARS-CoV-2; control; WHO; respiratory; cases; tract

Hibiscus sabdariffa (HS) has gained attention as an anti-hypertensive agent. In the present study, we hypothesized that anthocyanins from HS may attenuate salt-induced hypertension in rats by suppressing the components of renin-angiotensin-aldoslestrone system (RAAS). Hypertension was induced in the rats by adding 8% NaCl in their diet for six weeks. Wistar rats (n=5 each) were randomly divided into seven groups. Group 1 was the normentensive control group and was fed with normal rat chew and water ad libitum; groups 2 and 3 served as hypertensive control (negative untreated and positive treated with captopril 30mg/kg respectively); groups 4, 5, and 6 served as treatment groups and were administered with graded doses of anthocyanins( 50, 100, 200mg/kg respectively) while group 7 received both 100mg anthocyanins and 30mg captopril per day for 4 weeks. Using HPLC, anthocyanins were isolated from HS calyx following standard protocol. Anthocyanins significantly (p<0.05) reduced blood pressure and heart rate in hypertensive rats in a dose dependent manner. The blood pressure reduction by anthocyanins was associated with a reduction in serum ACE and plasma aldosterone in the hypertensive rats. The effects of anthocyanins on blood pressure and on biomarkers of RAAS were similar to those of captopril, a reference anti-hypertensive drug. The results suggest that anthocyanins exerts a significant (p<0.05) anti-hypertensive potency on rats, probably mediated by the reduction in components of the RAAS. Keywords: hypertension, anthocyanins, renin, aldosterone, rats

No abstract