Screening pregnant for hepatitis B infection on the basis of risk factors may not be effective. Education on modification of lifestyle and sexual behavior as well as non-selective screening of pregnant women for HBV infection is recommended.

Introduction: We assessed the knowledge of, attitude towards antimicrobial resistance (AMR) and practice of antimicrobial stewardship (AMS) among physicians in Nigeria to provide future guidance to the Nigerian National Action Plan for AMR. Methods: A descriptive cross-sectional questionnaire-based study explored the physicians' self-reported practice of antibiotic prescribing, knowledge, attitude and practice of AMR and components of ASPs. Results: The majority (217; 67.2%) of respondents prescribed antibiotics daily in their clinical practice AMR was recognized as a global and local problem by 308 (95.4%) and 262 (81.1%) respondents respectively. Only 91 (28.2%) of respondents have ever heard of antibiotic stewardship. The median AMR knowledge score was 40 (19-45)out of 45while that for ASP was 46.0(32-57) out of 60. There was significant statistical difference between the ASP median scores among the medical specialties category (P value <0.0001) More respondents had good knowledge of AMR than ASPs (82.7% versus 36.5%; p <0.0001). Conclusion: Respondents in this study were more knowledgeable about AMR than AMS and its core components.

Over the years, medical practice in Nigeria has evolved in scope and practice, in terms of changing disease patterns, patients' needs, and social expectations. In addition, there is a growing sentiment especially among the general public and some health workers that most doctors are bad managers. Besides drawing examples from some doctors in top management positions that have performed less creditably, critics also harp on the fact that more needs to be done to improve the training of doctors in health management. This article describes the role of doctors in this changing scene of practice and highlights the core areas where doctors' managerial competencies are required to improve the quality of healthcare delivery. Areas such as health care financing, essential drugs and supplies management, and human resource management are emphasized. Resources to be managed and various skills needed to function effectively at the different levels of management are also discussed. To ensure that doctors are well-skilled in managerial competencies, the article concludes by suggesting a curriculum review at undergraduate and postgraduate levels of medical training to include newer but relevant courses on health management in addition to the existing ones, whereas also advocating that doctors be incentivized to go for professional training in health management and not only in the core clinical specialties.

BackgroundPre-eclampsia (PE) poses a serious challenge to maternal and fetal health in Africa. It is associated with hemodynamic changes that may affect the internal carotid/ophthalmic artery circulation with consequent neuro-ophthalmic manifestations. Ophthalmic artery Doppler (OAD) ultrasound is an important tool that can be used to detect hemodynamic changes in PE and monitor its severity. In this study, we evaluated hemodynamic changes on OAD ultrasound in the ophthalmic arteries of pre-eclamptic women and compared these with values in healthy pregnant women.MethodsOAD parameters, such as, peak systolic velocity, peak diastolic velocity, end diastolic velocity, pulsatility index, and peak ratio, were measured on transorbital triplex ultrasound scan with a 7–10 MHz multifrequency linear transducer in 42 consenting pre-eclamptic patients and 41 pregnant controls matched for maternal age, gestational age, and parity at the Department of Radiology, University College Hospital, Ibadan. Univariate, bivariate, and receiver operating characteristic curve data analyses were performed. P<0.05 was considered to be statistically significant.ResultsMean resistivity index, pulsatility index, and peak systolic velocity were significantly lower in pre-eclamptic patients than in the controls. Mean peak diastolic velocity, end diastolic velocity, and peak ratio were significantly higher in the pre-eclamptic group. The receiver operating characteristic curve showed that the resistivity index (sensitivity 75%, specificity 77.8%) could distinguish mild from severe PE while the peak ratio (sensitivity 90.5%, specificity 81.3%) could accurately detect PE.ConclusionOAD ultrasound can be used to monitor patients with PE for early detection of progression to severe forms before cerebral complications develop. OAD screening of patients at high risk for PE can also detect early changes of hemodynamic derangement.

Background: Extremity arterial injuries are an important cause of loss of life/limb after trauma. Early intervention is important for the good outcome. Objectives: The objective of this study is to review the pattern of presentation and study the factors that influences the outcome of extremity arterial injuries in our hospital. Patients and Methods: This is a retrospective study of all patients with injuries to the extremity arteries requiring surgical intervention from July 2007 to June 2015. Data obtained included biodata, ischemic time, arteries involved, surgical intervention, and outcomes and analyzed using SPSS version 22. Setting: Our hospital is the main referral hospital for vascular trauma serving four adjoining states in Nigeria and is linked to major cities by at least 3 Trunk-A federal roads. Subjects: The subjects are patients who were managed in our cardiovascular surgical unit for the study duration (July 2007–June 2015) who had extremity arterial injuries. Results: A total of 36 patients presenting with 40 arterial injuries in 37 limbs were studied. The mean age was 28.4 ± 10.3 years with male preponderance (88.9%). Gunshot injuries were the most common cause of arterial injuries (37.8%), followed by assault (27%). The mean time from injury to presentation for acute injuries was 20.4 h but 23 of the patients (63.8%) presented to the accident and emergency department within 12 h of injury. A limb salvage rate of 64.9% was achieved though ischemic times of ≥12 h were associated with poor outcomes. Conclusion: Prolonged ischemic time is associated with poor outcomes. Efforts should be put in place to reduce the limb ischemic times.