The importance of measuring the accuracy and consistency of research instruments (especially questionnaires) known as validity and reliability, respectively, have been documented in several studies, but their measure is not commonly carried out among health and social science researchers in developing countries. This has been linked to the dearth of knowledge of these tests. This is a review article which comprehensively explores and describes the validity and reliability of a research instrument (with special reference to questionnaire). It further discusses various forms of validity and reliability tests with concise examples and finally explains various methods of analysing these tests with scientific principles guiding such analysis.

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Aims and Objectives: Doppler ultrasound scan is a non-invasive and cheap tool that complements the roles of computed tomography, magnetic resonance imaging and catheter digital subtraction angiography in the screening, diagnosis and follow up of vascular diseases. In this study, we evaluated and described the findings of the Doppler ultrasound of the peripheral arteries performed at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Patients and Methods: All the findings of peripheral arterial Doppler ultrasound examinations performed at AKTH during a period of 18 months (from February 2012 to July 2013) were reviewed. All examinations were done using 7.5 MHz linear transducer connected to Mindary Digital Ultrasound Imaging System (Model DC-6; Shenzhen Mindray Biomed Electronics, Shenzhen, China). A 3.5 MHz convex transducer of the same machine was used in obese patients and those with severe subcutaneous oedema. Results: The findings of 50 males and 28 females were reviewed. Their mean age was 55.8 ΁ 17.9 years. Diabetic foot disease, intermittent claudication, gangrene and limb swellings were the most common indications for arterial Doppler examination of the lower limbs, constituting 32.1%, 20.5%, 16.7% and 15.4%, respectively. Significant luminal stenosis, total luminal occlusion and loss of arterial resistance were the most frequent findings, constituting 29%, 26.9% and 7.7%, respectively. Femoro-popliteal and below the knee arteries were commonly involved by these abnormalities. Arrhythmia, increased intimal media thickness and wall calcifications were the common compounding findings while diabetes and hypertension were frequently associated clinical problems of these patients. Conclusion: Doppler ultrasound has a high diagnostic yield in depicting abnormalities in patients with clinical features of peripheral arterial disease.

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Aims and Objectives: Carbapenemase production among clinical isolates of Enterobacteriaceae has been widely reported with prevalence rates ranging from between 2.8% and 53.6%. The aim of this study was to assess the prevalence of carbapenemase production among clinical isolates of Enterobacteriaceae from a Tertiary Hospital in Lagos, Nigeria, and to characterize the type of carbapenemase produced. Materials and Methods: Carbapenemase production was detected phenotypically using a commercially available combination disc test (Rosco Diagnostica carbapenemase detection Neo-Sensitab) containing inhibitors to the various carbapenemase classes. The Neo-Sensitabs were used for Enterobacteriaceae isolates that were resistant after the initial antibiotic susceptibility testing with meropenem (10 μg). Results: A total of 177 Enterobacteriaceae isolates were investigated and 27 (15.2%) were carbapenem-resistant. From the 27 carbapenem non-susceptible isolates, 22 (12.4%) were carbapenemase producers while 5 (2.8%) exhibited carbapenem resistance due to extended spectrum beta-lactamase production. Of the 22 isolates that were positive for carbapenemase production, 15 (8.5%) were metallo beta-lactamase (MBL) producers, 6 (3.4%) produced oxacillinase-48 while 1 (0.5%) produced both MBL and Klebsiella pneumoniae carbapenemase. Hence, the overall prevalence of carbapenemase-producing Enterobacteriaceae in this study was 12.4%. Conclusion: Carbapenemase-producing Enterobacteriaceae was indeed prevalent in our institution. The combination disc test was a cost effective and suitable method for the initial detection of carbapenemase-producing Enterobacteriaceae within the clinical setting especially when molecular detection methods are not available.

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Animal attacks and bite injuries are common occurrences as the natural habitat of animals is diminishing due to human encroachment. Individuals injured in animal attacks present with different types of injuries. Urgent and effective management of these injuries would have a significant effect on the final outcome. Rabies is a fatal disease in humans, and, till date, only those that received vaccination before the onset of illness survived this disease. The goal of the case reports presented in the article was to document the injuries suffered in animal bite injuries and add to the literature on the management with minimal complications.

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Background: Use of hearing impairment (HI) questionnaires has been an alternative to formal audiometry. Objective: To validate hearing handicap inventory for the elderly (HHIE) questionnaire and verify its suitability or otherwise as a screening instrument in low-resource clinical settings. Subjects and Methods: A cross-sectional analytical study deployed the HHIE questionnaire to detect emotional and situational hearing handicaps (HHs) and assigned scores. Total scores were categorised as no, mild to moderate or significant HH. Pure tone audiometries (PTAs) were performed and PT average (PTAv) was calculated. HHIE scores were compared with the PTAvs. Validity of HHIE scores compared with PTAvs was explored with sensitivity, specificity and predictive values, while correlation coefficients combined age, HHIE scores and PTAv. Level of statistical significance was taken as P < 0.05 for all analyses. Results: One hundred and three subjects with mean age ± standard deviation, 71.3 ± 7.2 years were studied. Over 70% (71.8%, 74/103) were married, 63.1% (65/103) attended secondary school, 35.0% (36/103) were professionals and 45.6% (47/103) were retired. HHIE questionnaire revealed 59.2% (61/103) had handicap and PTA confirmed 47.6% (49/103) had HI. Comparing HHIE scores with PTAv, overall sensitivity was 79.6%, specificity was 59.3%, positive predictive value was 63.9% and negative predictive value was 76.2%. HHIE scores correlated significantly with PTAv (r = 0.527, P < 0.001) and there was no correlation between age and PTAv (r = 0.145, P = 0.143) and between age and HHIE scores (r = 0.187, P = 0.059). Conclusion: HHIE scores obtained from questionnaire can adequately quantify HI. HHIE questionnaire is a valid screening instrument to identify HH among elderly subjects.

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Aims and Objectives: This study was carried out among patients attending human immunodeficiency virus (HIV) treatment centres in Lagos to assess their sexual behaviour, conduct a health education intervention on safe sexual behaviour among the patients in the study group and re-assessing the sexual behaviour in both control and study groups. Subjects and Methods: A multi-stage sampling method was used to recruit 253 control and 256 intervention patients. The study sites selected were HIV treatment centres in Lagos State University Teaching Hospital (control), and Ifako-Ijaiye and Isolo General Hospitals (intervention). A pre-tested interviewer-administered questionnaire was used for data collection. The study site intervention consisted of health education seminars. Post-intervention data were collected after 3 and 6 months. Total study duration was about 10 months. Results: At baseline, there was no statistically significant difference in the sexual behaviour of respondents in both groups. Post-intervention, the notable effects of this intervention on the sexual behaviour of the study group were a 37.7% rise in condom use at last sexual exposure, a 74.3% increase in consistent condom use in the last 3 months, a 74.3% rise in consistent condom use with regular partners and a 39.0% rise in consistent condom use with casual partners. Conclusion: The modification of sexual behaviour of respondents achieved in this study has shown that dedicated interventions to increase the practice of safer sex can be effective. More of such interventions are required to stem the spread of HIV in Nigeria.

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Background: Diagnosis of antithrombin III (ATIII) deficiency as a common cause of thrombophilia is primarily based on the determination of antithrombin levels in plasma using a functional activity assay or an immunological assay, but local reference interval is lacking. Aims: The aim of the present study was to determine pattern of antithrombin activity and local reference intervals for ATIII among Nigerians. Subjects and Methods: A cross-sectional study was carried out among healthy blood donors at the Lagos University Teaching Hospital in Nigeria between the age range 18 and 65 years. Structured questionnaires were applied to obtain demographic and clinical history. Percentage ATIII activity was determined using immunoassay technique. Data were analysed using SPSS version 20.0. Results: One hundred and fifty-five healthy blood donors who participated in this study consisted of 84 males and 71 females. The mean age of participants was 35 ± 6.7 years with a modal age range at 25-49 years. The mean percentage ATIII activity was 91.2 ± 14.2% (confidence interval: 69.2-113.2). Reference interval estimated for all the subjects was 62.8-119.6%. ATIII activity was lower in females compared to males (91.1 vs. 94.2; P = 0.03). However, ATIII activity tended to decrease with increasing age (P = 0.001). Conclusion: Mean percentage ATIII activity for our study population was 91.2% with a reference interval of 62.8-119.6%. Reference interval for ATIII activity in African population is lower than documented Caucasian values.

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Introduction: Long stay in the Intensive Care Unit (ICU) after coronary artery bypass graft (CABG) surgery has been found to result in increased hospital mortality, poor long-term prognosis, prolonged hospital stay, and consequently, high cost and expenses. We, therefore, reviewed CABG surgery performed at the Madras Medical Mission Chennai, India, during a 3-month period to determine perioperative factors that are significant predictors of prolonged ICU admission. Methods: We retrospectively studied patients who had elective CABG surgery from November 2008 to January 2009. Information about the following perioperative variables were retrieved; patient demographics, history of co-morbid disease, pre-operative left ventricular (LV) function, the number of coronary vessels grafted, duration of bypass, the level of cardiovascular support post-bypass, the need for surgical re-exploration and duration of stay in the ICU. Prolonged ICU admission was defined as stay over 4 days after elective CABG surgery. Results: A total of 194 patients were reviewed, with males accounting for 84%, age ranged from 32 to 80 years, and duration of stay in the ICU from 2 to 14 days, with mean values of 58.06 ± 8.48 years and 3.96 ± 1.60 days, respectively. Univariate analysis showed significant differences in the number of patients with pulmonary hypertension (P = 0.002), mean bypass time (P = 0.018), requirement for LV support with inotrope (P = 0.021) and surgical re-exploration (P = 0.016) when patients with ICU stay ≤4 days were compared to those with stay over 4 days. Multiple regression revealed only LV support (β =0.69; P = 0.003) as the independent predictor of prolonged ICU stay. Conclusion: This review showed LV support with inotrope as the only independent predictor of prolonged ICU stay after CABG surgery. Therefore, an excellent perioperative care leading to a reduced requirement for LV support after cardiopulmonary bypass for CABG surgery should be the goal.

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Small incision cataract surgery (SICS) offers the benefits of a phacoemulsification (phaco) surgery without the attendant high cost, but it is not without certain risk such as nucleus drop into the vitreous as seen in phaco. A retrospective study of SICS and associated factors leading to nucleus drop during surgery, challenges of management and the visual outcomes. Of 793 eye surgeries performed during the study 586 were SICSs. Nucleus drop during SICS occurred in 0.68% of patients. Can-opener technique of capsulotomy, use of dispersive viscoelastic, diabetes mellitus, lack of anterior vitrectomy machine and poor access to immediate posterior vitrectomy were important problems in the management of the cases of nucleus drop in this study. The visual outcomes were poor in all the cases of nucleus drop. Careful patient selection for SICS and the use of continuous curvilinear capsulorhexis are advocated. An interior vitrectomy machine should be available to all cataract surgeons. It is good professional practice to be acquainted with the available vitreo-retina surgeons for urgent assistance in cases of nucleus drop.

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Background: Cancer survivors are at an increased risk for developing second cancers than the general population. In recent times detection of a new second primary following the index primary has increased due to refinement of existing diagnostic tools and development of newer modalities of diagnosis combined with better understanding of patterns of inheritance, risk factors and environmental influences. Today with improvement in Cancer management the average lifespan of cancer survivors have increased along with the increase in detection of both synchronous and metachronous malignancy with increase in disease free survival. With the improved cancer survival, second primary malignancy has become an important issue among cancer survivors and an increased burden on the treating oncologists and health care system. Aims and Objective: To report the trends of second malignancy in a tertiary care centre in Central India with review of relevant literature. Methods: A hospital based retrospective collection of data of patients diagnosed with second primary malignancy based on Warren and Gates Criteria (1932) over 2 years in the Department of Surgical Oncology of a tertiary care centre in Central India. Conclusion: Secondary primary malignancy needs to be separated from metastasis as the latter implies progression in disease and portends poor survival. Operable synchronous secondary primary malignancy can be tackled in the same sitting thereby reducing the load on the overburdened healthcare system in India. Increase in awareness of secondary primary malignancy leads to better chances of detection management and hence chances of improved survival.

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