Introduction: Virginia Apgar developed the Apgar scoring which has shown relevance in assessing the general well-being of the newborn at delivery and also determining the response and effectiveness of resuscitation. This includes the 1^st, 5^th, and even the 10^th and 20^th min scores. However, the first and fifth scores have been severally used in defining perinatal asphyxia. This study, therefore, seeks to assess the performance of Apgar scoring in a resource-limited setting in determining hypoxic-ischemic encephalopathy (HIE). Materials and Methods: This was a retrospective study. The medical records of 142 admitted newborns with a diagnosis of perinatal asphyxia were reviewed over a 1-year period. Results: There were 86 males and 56 females with perinatal asphyxia and a male-to-female ratio of 1.5:1. Most cases had a 1 min Apgar score in the range of 4–5 (62.0%), whereas using the 5^th min Apgar score, majority of the cases had scores of 6 and more. Sixty-five cases (45.8%) had HIE, whereas Stage 1 HIE was the most recorded form of encephalopathy. The 1^st min Apgar scoring showed that most cases with a score of 4–5 had Stage 1 HIE, whereas all the nine cases with Stage 3 HIE had a score of 0–3 (Fisher's exact test = 132.074; P = 0.00); furthermore, most cases with Stage 1 HIE had a 5 min score of 6 and above, but all the cases with Stage 3 HIE had a score between 4 and 5 (Fisher's exact test = 49.024; P = 0.00). Conclusion: The Apgar score still remains an important tool in neonatal resuscitation and monitoring; asphyxiated neonates need to be actively and effectively resuscitated.

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Bilateral transverse facial clefts are a rarity and are often isolated without other craniofacial deformities. The goals of surgery are to reestablish function and an esthetically pleasing outcome through the reconstruction of a functioning orbicularis oris muscle ring with minimal scars. We report our experience in the reconstruction of isolated bilateral transverse facial clefts in two patients using Kaplan's technique and a straight-line skin closure. There was a satisfactory preservation of the continuity of the vermillion at the commissure, as well as restoration of both the sphincteric function of the orbicularis oris muscle and size of the oral aperture in the patients.

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Background: Spiritual care is an important aspect of holistic care in nursing, and as a result, some nursing schools have begun offering courses in spirituality. Even at that, studies in some countries have shown that nursing students' perception on spirituality and spiritual care was not sufficient and most professional nurses still feel inadequately prepared to provide spiritual care, showing the inadequacy of the education that was received, thus, hindering the patients from receiving holistic care. Objectives: This study has the broad objective of identifying the perception of spirituality and spiritual care and barriers to the provision of spirituality care among undergraduate nurses in the College of Medicine, University of Lagos. Materials and Methods: This is a descriptive cross-sectional study, utilizing stratified random sampling technique. A total of 117 out of 157 students of the nursing department, University of Lagos, ranging from 200 level to 500 level participated in the study. Data were collected using structured self-administered questionnaire, with a reliability coefficient of 0.509, which was validated using face and content method. Analyses were done using Statistical Package for Social Services version 14 and presented using tables, percentages, and pie chart. Results: Result shows that of the respondents, 67.9% scored <50% of the questions pertaining to perception on spirituality and spiritual care. This shows that nurses had poor perception regarding spirituality and spiritual care, with majority (68.7%) of them perceiving spirituality as religion. Barriers to the provision of spirituality care were also identified with “lack of confidence” being the most common. Conclusion: The findings of this research showed that nursing students' perceptions of spirituality and spiritual care was poor which had no relationship with their academic level or kind of religion, thus, showing that the education being provided on this part of holistic care is not sufficient, requiring an in-depth adjustment of nurses' educational curriculum on the aspect of spiritual care.

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Objectives: Mobile health (mHealth) is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1%) had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4%) were aware of the use of mobile phones in health-care delivery. Only three (27.3%) (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine) out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5%) had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

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Background and Objective: The recent trend in cataract surgery is the use of regional ophthalmic nerve blocks or topical anesthesia. We determined and compared the effect of peribulbar and subtenon block on pain and patients' satisfaction, following small incision cataract surgery (SICS). Methods: This was age-sex-matched comparative study involving 462 ASA I-III patients, aged 18 years and above scheduled for SICS. They were assigned to receive either peribulbar block (Group P) or subtenon (Group ST). The pain score and patients' satisfaction with the anesthetic experiences were recorded by a study-masked anesthesiologist during surgery and postoperatively at 30 min and 1, 2, 4, and 24 h. Results: The median numeric rating score was significantly lower in the subtenon group than the peribulbar group: During surgery, Group ST 1 (1) versus group P 1.5 (2.25), P < 0.001. At 30 min after surgery, Group ST 0 (1) versus Group P 1 (2.5) versus P < 0.001, and at 1 h after surgery, Group ST 0 (1) versus group P 1 (2), P = 0.002. Ten patients had akinesia in the peribulbar group compared with one in the subtenon group. Chemosis was significantly higher in the subtenon group 10 (3.2%) than in the peribulbar group 0 (0%), P = 0.035. Similarly, a significant difference was not with subconjuctival hemorrhage; subtenon 14 (4.5%) versus peribulbar 2 (1.3%), P = 0.105. Conclusion: The use of subtenon block resulted in lower pain scores and higher patient's satisfaction than peribulbar block. However, subconjuctival hemorrhage and chemosis were more common with subtenon block.

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Background: There are pointers in existing literature to the stressful nature of residency program, thereby placing training physicians at increased risk of psychological distress. Objectives: The study identified perceived stress, its sources, training satisfaction, and the associated sociodemographic characteristics among resident doctors. Materials and Methods: A total of 405 self-administered questionnaires were given to all attendees of the National Postgraduate Medical College Revision Course. The questionnaires sought information on sociodemographic variables, sources of stress, and training satisfaction. Only 20 questionnaires were not returned. Data were collated and analyzed. Results: A majority of the respondents were male (69.1%), mostly between 31 and 35 years of age. Most (80%) of the respondents were married while 51.4% had over 4 dependents. All the respondents reported a significant level of stress, and different sources of stress were identified. Only 12 (3.1%) of the respondents were satisfied with the quality of training being received in their institutions. Conclusion: Our study found residency training to be stressful for doctors and often compounded by identifiable variables as shown in this study. Such stressful experience can, in turn, have negative impacts on their physical along with mental well-being and the patient care. Thus, there is a need for relevant stakeholders to review the structure of residency program with the view of addressing “modifiable risks” of stress among would-be specialists.

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Background and Objective: The rubber dam is used in dentistry to create saliva-free working environment during operative procedures. Despite its numerous advantages, utilization is poor in dental schools. We sought to determine undergraduate dental students' perception, educational satisfaction, and attitude regarding the use of rubber dam. Materials and Methods: This cross-sectional survey was carried out among 5^th and 6^th year undergraduate dental students. A structured questionnaire was developed that sought their perception, educational satisfaction, and attitude regarding the use of rubber dam. Data collected were analyzed using IBM SPSS version 21.0. P <0.05 was considered statistically significant. Results: One hundred and nine students participated in the study; 66 (60.6%) females and 43 (39.4%) males with a mean age of 23.4 ± 2.02. Most of the students, i.e., 73 (67%) were satisfied with their classroom experience with regard to the use of rubber dam but were least satisfied with their laboratory and clinical training. There was a statistically significant association between the students' satisfaction with their training in the use of rubber dam and the confidence to use the rubber dam on their patients (P = 0.001). Conclusion: The students agreed to the importance of rubber dam but were not satisfied with their hands-on clinical training. The use of rubber dam postgraduation may be influenced by the dental educator's method of training, motivation, and consistency in its use. Students who acquire competence and are confident in the use of rubber dam during their undergraduate training are more likely to continue to use the skills following graduation.

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Background: Patients who come for radiological investigations often have anxiety due to a number of factors – the fear of hospitals, injections, diagnosis, or being in an enclosed space. Such anxiety needs to be allayed to prevent delays, incomplete tests, or cancellations. The study aims to assess the prevalence of anxiety and depression among patients undergoing radiological investigations in a tertiary hospital. Materials and Methods: Two hundred and three literate, consenting adults who presented to the Radiology Department of a Teaching Hospital, from May 2015 to April 2016, were recruited consecutively. Children and adults who could not read/write were excluded from the study. Instruments used were a sociodemographic questionnaire, the State-Trait Anxiety Inventory (STAI) for state anxiety, and Hospital Anxiety and Depression Scale (HADS). Data were analyzed using IBM SPSS for Windows version 22. Results: The mean HADS score for anxiety was 5.0 + 4.4 (Range 0–12), and for depression, the mean score was 5.2 + 4.3 (Range 0–19). Twenty-nine (14.3%) respondents screened positive for depression, while 27 (13.3%) had suspected borderline depression. Thirty (14.8%) screened positive for anxiety, with 27 (13.3%) being borderline anxiety as well. Anxiety and depression were the most common among those with an unknown diagnosis (4.4% and 6.4%, respectively). The mean STAI score was 46.48 + 7.2 (Range 25–67). Thirty (14.8%) respondents had anxiety, while 27 (13.3%) were borderline. Ninety-three (45.8%) had state anxiety, the most common among those with unknown diagnoses (15.3%). Depression was mostly seen among those undergoing magnetic resonance imaging (6.9%) P < 0.05. Conclusion: State anxiety, probable anxiety disorder, and probable depressive disorder were quite common with a prevalence of 45.8%, 14.8%, and 14.3%, respectively; these should be addressed among participants going for radiological investigations, especially those with an unknown diagnosis. A pretest counseling session is a good recommendation for such participants to allay anxiety.

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Background: Lack of capacity to implement programs effectively and low public education about malaria is some of the factors that Nigeria governments must address to effectively combat malaria. Methods: This descriptive cross-sectional study assessed the knowledge and implementation of the National Malaria Control Programme (NMCP) among health-care workers in the primary health-care centers in Ogun state. Three hundred and twenty-five respondents were recruited into the study using cluster sampling method. A pretested self-administered questionnaire was used to collect necessary information. Analysis and statistical calculation was done using SPSS version 20.0. Relationships between categorical variables were tested using Chi-square test with P value at 0.05. Results: One hundred and twenty-five (38.5%) of the respondents were from Ado-odo/Ota local government areas (LGAs), 120 (36.9%) of the respondents were from Ijebu-ode LGA and 80 (24.6%) were from Ewekoro LGA. About 37.8% of the respondents were within age range of 45–54 years, with mean of 41.7 ± 8.5. Over 90% of the respondents knew the mode of transmission of malaria, <50% of them could identified case definition of simple and complicated malaria. Large percentage of the respondents knew the signs and symptoms of simple malaria. The respondents who were older (P = 0.004) with more than 15-year work experience (P = 0.006) had good knowledge score of the NMCP. Conclusion: Knowledge and implementation of NMCP by health-care workers in some of the LGAs in this study was inadequate. Regular visit to the health facilities, especially those in the remote areas by the staff of malaria control unit were recommended.

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Background and Objective: Hypertension alone accounts for 50% of death from stroke. Its ability to induce endothelial dysfunction leads to the release of von Willebrand factor (vWF), a prothrombotic glycoprotein. The increase secretion of vWF may account for increased risk of stroke in hypertensive disorders. This study aimed to determine the vWF:antigen (Ag) levels among hypertensives and assess its relationship with blood pressure and occurrence of stroke in hypertensives. Subjects and Methods: The study included 66 hypertensives, 33 with stroke (HS) and 33 without stroke (HWS), and 33 controls matched for age and sex. Structured questionnaires were used to obtain biodata and clinical information. Blood pressure was taken after 15 min rest. Four milliliters of blood was collected into 0.1 ml of 3.2% trisodium citrate for vWF:Ag assay and 4 ml into K-ethylenediaminetetraacetic acid anticoagulant bottles for blood grouping and erythrocyte sedimentation rate. Data were analyzed with SPSS version 21. Confidence interval was set at 95%. Results: Mean vWF:Ag levels were significantly higher in hypertensives compared with nonhypertensives (P = 0.005), but no statistically significant difference was observed between HS and HWS (P = 0.874). A positive correlation of vWF with systolic blood pressure was observed (r = 0.335, P = 0.001). Conclusion: Our study suggests that higher systolic blood pressure is associated with higher levels of endothelial activation and release of vWF.

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The incidence of blunt abdominal trauma has increased in recent years; however, relatively little attention has been paid to instances of its sequelae, especially in childhood. Small bowel stricture following a history of abdominal trauma is a rare cause of small bowel obstruction and there have been few reports examining its occurrence. We are presenting here a case of posttraumatic double ileal stenosis in a 4-year female child.

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Background: Excessive left ventricular mass (LVM) and diastolic dysfunction are associated with higher morbidity and mortality among patients with chronic kidney disease (CKD). Objective: The objective of the following study is to determine the prevalence of increased LVM index (LVMI), pattern of abnormal LV geometry, and diastolic dysfunction in Nigerian CKD children and to establish a relationship of these with estimated glomerular filtration rate (eGFR). Subjects and Methods: Cross-sectional comparative study of LV structure and diastolic function of 21 children with CKD age- and sex-matched and controls asymptomatic for cardiac disease. Results: The median LVMI was 62.19 (34.7) g/m² in CKD patients compared with 52.89 (30.2) g/m² in controls (P = 0.04). Excessive LVMI was present in 3 (14.3%) individuals compared with none (0%) of the controls P < 0.001. The prediction equation for LVMI using eGFR is: LVMI = 123.11+ (−0.48) × eGFR ml/m²/min. Abnormal LV geometry was present in 19.05% of the CKD patients and none of the controls (P = 0.04). CKD stages differed significantly with respect to the presence of abnormality with LV geometry (P = 0.04). LV diastolic dysfunction was present in 4 (19.1%) individuals (2 each had impaired relaxation and restrictive patterns) compared with 1 (4.8%) control (restrictive pattern)-P < 0.001. Children with CKD who had abnormal LV geometry had 48 times increase in the odds of having LV diastolic dysfunction when compared with those having normal LV geometry (confidence interval = 2.31–997.18, P = 0.012). Conclusion: Excessive LVM, LV hypertrophy and diastolic dysfunction are significantly more common in children with CKD compared with controls.

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