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Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

A ureterocoele with stone may present with recurrent flank pain and urinary tract infection. Medical expulsive therapy (MET) may be associated with symptomatic aggravation when there is ureteric obstruction or stone impaction. The definitive treatment is by deroofing and retrieval of the stone endoscopically or by open intravesical approach. We report a case of symptomatic aggravation of right orthotopic blind ureterocoele stone and contralateral impacted left ureteral meatus stone following MET using tamsulosin who was treated by open deroofing and retrieval of stones. Case presentation: This is a 17-year-old lady who presented with recurrent suprapubic colicky abdominal pain that was aggravated by Medical Expulsive Therapy (MET) using tamsulosin but improves with opioid analgesics. Abdominopelvic ultrasound done before MET revealed bladder stone but the repeat ultrasound after the MET revealed bilateral ureterocoele with stones. A computerized tomographic scan urogram (CTU) revealed a right ureterocoele stone and bladder stone. She had bladder exploration with the finding of blind right orthotopic ureterocoele containing stone measuring 2.5cm x 3cm and an impacted peeping left ureteric meatus stone of 1.2x1 cm. She had deroofing of the right ureterocoele and retrieval of the stones bilaterally. The stitches and stents were removed and discharged on 9 and 10 postoperative days respectively. The postoperative period was uneventful. Conclusion: Medical expulsive therapy may be associated with symptomatic aggravation in blind orthotopic ureterocoele and sizeable impacted ureteral meatus stone. Findings of the Imaging studies may be conflicting and inaccurate. Deroofing of the ureterocoele and stone retrieval is associated with a good outcome.

The study investigated effects of rainy and dry periods on the ovaries of wild adult Clarias gariepinus in Zaria, kaduna State Nigeria. Twenty-four wild adult catfish with average weight of 1000.00 ± 0.00 gm was used during both periods. They measured a standard body length of 50.17±1.01 cm (rainy) and 44.83 ± 2.09 cm (dry). The fish were sourced from Zaria dam and transported live to Gross Anatomy Laboratory in Ahmadu Bello University Zaria. Each fish was euthanized using tricaine anaesthetic at 8 drops/litre of water. The ovaries were extracted, weighed and fixed in Bouin’s fluid for 24 hours, and processed histologically. Grossly, the ovaries were observed to be well-developed and highly vascularized during rainy period while, regressed and poorly vascular- ized ovaries were seen during dry pe- riod. The mean weight of the ovaries (0.025) and Gonado-somatic index (GSI) value (0.034) were significantly higher during rainy period. Histologically, the ovaries were predominated by vitellogenic and post-vitellogenic follicles during rainy period while, pre-vitellgenic follicles predominates dry periods. The tunica albuginea and interstitial connective tissues were thin during rainy period but thick during dry period. Hence, the result of this study revealed that wild adult catfish spawns during rainy period while, dry period is characterized by low gonadal activities in Zaria, Nigeria.

The aim of this study was to analyze the prevention and control practices against Zika virus (ZIKV) infection among pregnant women in Malaysia. A cross-sectional study was conducted among pregnant women who received antenatal care. Only 7.8% reported that they abstained from sex or used barrier methods during sexual intercourse to prevent ZIKV transmission. The odds of abstaining from sex or using barrier methods were significantly higher among the Chinese ethnic group than the Malay ethnic group (odds ratio [OR] = 4.569; 95% confidence interval [CI]: 2.696-7.743). A total ZIKV knowledge score of 12-24 was also significantly associated with higher odds of abstaining from sex or using barrier methods than a score of 0-11 (OR = 2.819; 95% CI: 1.682-4.725). In total, 38.6% of women had a higher mean total score for all the current mosquito control practices than they did before hearing of ZIKV. Participants living in bungalows or village houses (OR = 2.006; 95% CI: 1.023-3.936) and low-rise houses (OR = 1.566; 95% CI: 1.109-2.212) were more likely to have a higher mean total score of current mosquito control practices than the practices before hearing of ZIKV compared to those in high-rise houses. The lack of ZIKV knowledge and control practices provides insight for the pre-emptive and prompt development of health education systems for pregnant women during antenatal care visits.

Background: Although large families are desired in Nigeria, women tend to want fewer children than men but are often unable to limit or space childbirth due to gender dynamics within relationships. Studies have identified men as a significant barrier to the use of contraceptives by their wives. The study explored married men’s knowledge and perception on family planning (FP), involvement in FP, barriers and facilitators of male involvement (MI) in FP in Sokoto Metropolis.Methods: A qualitative study was done among married men in Sokoto Metropolis in November 2017. Four focus group discussions were conducted among thirty-two men grouped based on educational status and age. Data was transcribed verbatim and a content analysis on emerging themes was done.Results: All the participants were aware of FP and most of them said that it is beneficial to everyone in the community. Most of the participants perceived that FP is an issue for both men and women. All the participants said that men should be involved in FP. The barriers to MI in FP mentioned were lack of knowledge on FP and poverty while increasing awareness on FP, religious leaders and traditional rulers championing FP, and making FP free were the facilitators suggested.Conclusion: The participants said that FP is beneficial to everyone in the community and men should be involved in FP. Traditional and religious leaders should be made the champions of FP in their various communities to improve acceptance and utilisation.

Accumulation of fat in the body has been linked with an increased body mass and subsequently blood sugar level, which enhances hepatocellular damage. Increased in activities of serum liver enzymes in the above conditions has been extensively used as a mark of liver disease and predicted development of type 2 diabetes. The main objective of this research work was to investigate the effect of resveratrol on body weight, blood glucose level, and liver enzymes in rabbits. Rabbits were distributed into six groups of five animals each: Group 1 = negative control (NC), Group 2 = cholesterol diet (ChD/CD) alone, Group 3 = resveratrol 200 mg/kg (Resv200), Group 4 = resveratrol 400 mg/kg (Resv400), Group 5 = CD + Resv200, and Group 6 = CD + Resv400. Animals were controlled according to the protocol guiding the use of research animal in Ahmadu Bello University (ABU), Zaria, Nigeria. The regiments were given for 8th weeks period. Glycaemic level and live weight of the animals were measured weekly for 8th weeks consecutively. After the study time, rabbits were anesthetized using ketamine to induce unconsciousness. Thereafter, blood sample (3 ml) was collected via cardiac puncture and centrifuged for serum extraction for assessment of serum activities of liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). The body weight increased after the 5th week of ChD consumption in resveratrol-treated groups and resveratrol + ChD, ChD + Resv200, and ChD + Resv400 groups. Glycaemic profile in ChD group increased after the fifth week of ChD intake compared to the groups given Resv200, Resv400, Resv200 + ChD, and Resv400 + ChD. Serum activities of liver enzymes showed significant (P < 0.05) reduction in ALT (ChD + Resv200), AST (ChD + Resv400), and ALP (ChD +Resv200), relative to ChD alone group. In conclusion, the decrease in glycaemic level, body weight of the rabbits and serum activities of the liver enzymes despite ChD consumptions demonstrated the beneficial effect of resveratrol.

Objective: This study evaluated the knowledge and self-reported confidence of antimicrobial stewardship (AMS) among pharmacy students in Malaysia and Nigeria. Methods: A cross-sectional study was conducted among final year undergraduate pharmacy students in a university from both Nigeria and Malaysia using a 59-item online questionnaire. Results: A total of 150 final year undergraduate pharmacy students completed the questionnaire. Exposure to infectious diseases clerkship was higher among the Malaysian students (78.2% versus 25.4%; p < 0.001). Overall, the knowledge score for antibiotic resistance and AMS were comparable (6.2 ± 1.5 and 3.6 ± 1.2, respectively versus 5.9 ± 1.6 and 3.3 ± 1.3). The knowledge of antibiotic therapy was higher among the Malaysian students (5.4 ± 1.8 versus 4.2 ± 1.8; p < 0.001) while self-reported confidence to participate in AMS was higher among the Nigerian students (median 48.0, IQR 26 – 75 versus median 36.5, IQR 15 – 75; p < 0.001). Conclusions: Pharmacy students in Malaysia and Nigeria have appreciable knowledge of antibiotic resistance, antibiotic therapy and AMS. More training on topics is recommended to improve the skills and competency of future pharmacists to participate in AMS.

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Background: Caesarean section is the most significant obstetrics operative intervention globally. Good postoperative experience after caesarean section is important because there is need for the mother to recover from surgery and take care of her baby. The aim of this study was to assess the experience of women that had caesarean section in the first 24 hours postoperatively. Materials/methods: This was a cross-sectional study conducted among women that had elective and emergency caesarean section. They were followed up to 24 hours post-operative. The primary outcome measures were pain score and satisfaction. Secondary outcome measures were time of mobilization, time of commencement of oral feeds and time of initiation of breastfeeding. Data analysis was carried out using Statistical Package for Social Sciences version 22. Results: The median pain scores among those that had emergency and elective caesarean section ranged between 2 and 3 at all points of pain assessment. The satisfaction was good among 66.1% that had emergency caesarean section and 71.2% among those that had elective caesarean section. However, the difference was not statistically significant (χ2 = 0.546, p = 0.761). More than 90% of the participants that had either emergency or elective caesarean section did not ambulate within the first 24 hours after caesarean section and there was no association between the time of ambulation and the type of caesarean section (χ2 = 0.005, p = 0.941). Conclusion: The participants had adequate pain relief and majority were satisfied with the pain relief. However, the optimum satisfaction was not achieved. The participants did not ambulate early and did not initiate breast-feeding early. Recommendation: Further research is recommended to assess other factors that affect patient's satisfaction and ambulation so as to improve on patient's postoperative care.

Introduction: Cerebro-Spinal Meningitis (CSM) is an acute illness affecting surrounding layers of the brain and spinal cord, mostly caused by bacterial infection. The disease is responsible for the occurrence of epidemic meningitis in the African Meningitic belt. For many years, this region has experienced a large serogroup A epidemic every 7-10 years. A sharp decrease in the number of reported cases was demonstrated in countries where Men Afrivac has been introduced. However, serogroup replacement with serotype C was noted in the region, which has posed a serious threat to eliminating CSM epidemics. We describe the characteristics of cerebrospinal meningitis cases in the 2017 outbreak in Sokoto state, Nigeria. Methodology: We obtained CSM data from the state epidemiology unit from 7th February to 24th May 2017. We extracted data on demographic characteristics, clinical features, case management and outcome of cases. We used Microsoft Excel and SPSS to analyze the data for proportions, cross-tabulations and chi-square test to find associations between variables. Results: A total of 4969 CSM cases were recorded, with 283 deaths (case fatality rate: 5.7%). The cumulative attack rate was 96.4/ 100,000 populations. The highest proportion of cases was among ≥ the 15-year age group 2063(41.5%), and males were more affected, 2843(57.2%). Of the total 4969 suspected CSM cases, specimens were collected for only 225 (4.4%) cases, of which 58 (25.8%) were positive. Most 48 (82.8%) of the positive specimen were of NmC serotype. Only age was found to predict outcome (aOR: 1.52; 95% CI= 1.18 – 1.97). Conclusion: Sokoto State outbreak of Cerebro-spinal meningitis in 2017 was huge and largely caused by NmC. Those aged less than 15 years might be at higher risk of dying from CSM and we therefore recommend that specific preventive interventions such as vaccination and awareness creation should target this age group.

Toxoplasma gondii infection causes high rate of gestational and congenital infection across the globe and is considered a both a public health problem and a neglected disease. The study was carried out to determine the prevalence of anti-Toxoplasma gondii antibodies and the associated risk factors among pregnant women attending antenatal care in some Primary Health Centres in Jos, Plateau State, Nigeria. In this cross-sectional study carried out within 5 months between Jan – May 2019, a total of 182 blood samples were collected from consenting pregnant women. Structured questionnaire was used to obtain data on socio-demography and risk factors. Three millilitres (3 ml) of blood samples were collected from the study participants. Sera were separated from the blood and evaluated for anti-Toxoplasma gondii antibodies (IgG and IgM) using enzyme-linked immunosorbent assay (ELISA). The data collected from the experiment were analysed using Statistical Package for the Social Sciences. Out of the 182 samples examined, 84 (46.2%) had anti-Toxoplasma gondii IgG antibody, 2 (1.1%) had IgM antibody while 98 (53.4%) were neither seropositive for IgG nor IgM. Trimester of pregnancy was significantly associated with prevalence of anti-Toxoplasma IgM antibody. In conclusion, Toxoplasmosis is prevalent in Jos. Eleven out of every 1000 women (i.e. 1.1%) had recent toxoplasmosis and 53.4% were not protected against primary infection thereby underscoring the need for prevention and control during pregnancy through enlightenment.

Background Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria. Methods This is a 20-year retrospective study of patients managed for peno-scrotal wound defects by the Urology Unit in the Department of Surgery of our hospital from January 2001 to December 2019. Data were collected from the patients’ case notes and entered into a proforma. Data were analysed using SPSS version 25.0. Results A total number of 54 patients with peno-scrotal wound defects were managed within the study period with the mean age of 46.27 ± 22.09 years and a range of six weeks to 107 years. The wound defects were sequelae of Fournier’s gangrene in 42 patients (77.8%) and traumatic in 12 patients (22.2%). Healing by secondary intention was achieved in 20 patients (37.0%). Direct closure was done in 17 patients (31.5%), skin graft in nine patients (16.7%), and advancement flap in eight patients (14.8%) depending on the location and size of the defects. Fourteen patients (26.0%) developed surgical site infection ± wound dehiscence and partial graft loss. The complication rate was higher in post-Fournier’s gangrene wound defects, but without statistical significance (p = 0.018). Conclusion Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. Smaller wound defects were healed by secondary intention, while larger defects required either direct closure or the use of advancement flap or skin grafting depending on the location and size of the wound. The study reported a higher post-repair complication in patients that had Fournier’s gangrene.

Rationale and Objective This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. Methods PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. Results After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64–0.69), 0.78 (CI: 0.76–0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80–18.43), 0.31 (CI: 0.22–0.44), and 3.87 (CI: 2.83–5.29), respectively. Conclusion Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.

Summary Background There is anecdotal evidence for Lassa virus persistence in body fluids. We aimed to investigate various body fluids after recovery from acute Lassa fever, describe the dynamics of Lassa virus RNA load in seminal fluid, and assess the infectivity of seminal fluid. Methods In this prospective, longitudinal, cohort study we collected plasma, urine, saliva, lacrimal fluid, vaginal fluid, and seminal fluid from Lassa fever survivors from Irrua Specialist Teaching Hospital in Edo State, Nigeria. Inclusion criteria for participants were RT-PCR-confirmed Lassa fever diagnosis and age 18 years or older. Samples were taken at discharge from hospital (month 0) and at months 0·5, 1, 3, 6, 9, 12, 18, and 24 after discharge. The primary objective of this study was to quantitatively describe virus persistence and clearance and assess the infectivity of seminal fluid. Lassa virus RNA was detected using real-time RT-PCR. Infectivity was tested in cell culture and immunosuppressed mice. We used a linear mixed-effect model to analyse the dynamics of virus persistence in seminal fluid over time. Findings Between Jan 31, 2018, and Dec 11, 2019, 165 participants were enrolled in the study, of whom 159 were eligible for analysis (49 women and 110 men). Low amounts of Lassa virus RNA were detected at month 0 in plasma (49 [45%] of 110 participants), urine (37 [34%]), saliva (five [5%]), lacrimal fluid (ten [9%]), and vaginal fluid (seven [21%] of 33 female participants). Virus RNA was cleared from these body fluids by month 3. However, 35 (80%) of 44 male participants had viral RNA in seminal fluid at month 0 with a median cycle threshold of 26·5. Lassa virus RNA remained detectable up to month 12 in seminal fluid. Biostatistical modelling estimated a clearance rate of 1·19 log10 viral RNA copies per month and predicted that 50% of male survivors remain Lassa virus RNA-positive in seminal fluid for 83 days after hospital discharge and 10% remain positive in seminal fluid for 193 days after discharge. Viral RNA persistence in seminal fluid for 3 months or more was associated with higher viraemia (p=0·006), more severe disease (p=0·0075), and longer hospitalisation during the acute phase of Lassa fever (p=0·0014). Infectious virus was isolated from 48 (52%) of 93 virus RNA-positive seminal fluid samples collected between month 0 and 12. Interpretation Lassa virus RNA is shed in various body fluids after recovery from acute disease. The persistence of infectious virus in seminal fluid implies a risk of sexual transmission of Lassa fever. Funding German Federal Ministry of Health, German Research Foundation, Leibniz Association.

Objective: To determine the impact of cancer on quality of life and depression among caregivers. Study Design: Cross-sectional survey. Place and Duration of Study: Anmol Hospital, Lahore, from Jul 2019 to Jan 2020. Methodology: Data collected from caregivers of female cancer patients by purposive sampling technique using Standardized Questionnaire of Caregiver Assistance Scale and emotional distress was assessed by the Profile of Mood States. Data were entered into Statistical Package for Social Sciences for statistical analysis. Results: Among 110 participants (caregivers of female cancer patients) 28 (25.5%) were female while 82 (74.5%) were male caregivers. Patients other than breast cancer were 79 (71.8%), while breast cancer patients were 31 (28.2%). There was a significant association between caregiver health, quality of life and level of depression, one year ago, and at current with p-values= 0.001, 0.001 and 0.01 respectively. Conclusion: There was a negative impact on the health and quality of life of caregivers. Their health was better in the beginning but with time, their lives became more difficult.

Water pollution is an international phenomenon and one of the fundamental issues in many developing nations including Africa. Many areas of groundwater and other sources of water are contaminated with heavy metals, chronic organic pollution, and waste materials that have a destructive effect on public health and the environment. The paper investigates into the problem of water pollution in Dala, under the Local Government of Kano State, Nigeria with the aim to discover the sources of water pollution, the effects of water pollution on public health and environment, and to make recommendations for the same. The study is based on a primary survey conducted with citizens of the area and also on secondary study of reports and similar research. The study revealed that there are very high incidences of poor waste disposal practices resulting ultimately in pollution of the water. The study highlights that the pollution in turn impacts the citizen’s environment negatively. Water pollution is the major environmental impact affecting the study area and recommendations have been made in terms of better sanitary practices, heightened awareness of the public, adequate investment in waste control and management, effective implementation of judicial measures and by following the monthly environmental sanitation scheme.

OBJECTIVE Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. STUDY DESIGN This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight

This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE).In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate-severe grade EEG at 48 hours. Standardized signal preprocessing was used; the power spectral density was computed without interpolation. Multivariate binary logistic regression was used to identify which MABP time and frequency domain metrics provided improved predictive power for adverse outcomes compared with standard clinical predictors (5-minute Apgar score and cord pH) using receiver operator characteristic analysis.Ninety-one infants met inclusion criteria. The mean gestational age was 38.4 ± 1.8 weeks, the mean birth weight was 3,260 ± 591 g, 52/91 (57%) of infants were males, the mean cord pH was 6.95 ± 0.21, and 10/91 (11%) of infants died. At 48 hours, 58% of infants had normal or mildly abnormal EEG background and 42% had moderate or severe EEG backgrounds. Clinical predictor variables (10-minute Apgar score, Sarnat stage, and cord pH) were modestly predictive of 48 hours EEG outcome with area under curve (AUC) of 0.66 to 0.68. A composite model of clinical and optimal time- and frequency-domain blood pressure variability had a substantially improved AUC of 0.86.Time- and frequency-domain blood pressure variability biomarkers offer a substantial improvement in prediction of later adverse EEG outcomes over perinatal clinical variables in a two-center cohort of infants with HIE.· Early outcome prediction in HIE is suboptimal.. · Patterns in blood pressure physiology may be predictive of short-term outcomes.. · Early time- and frequency-domain measures of blood pressure variability predict short-term EEG outcomes in HIE infants better than perinatal factors alone..

BACKGROUND: Cough is a defense mechanism that protects the airways and lungs in response to airway irritation. The sensory neurons involved in detecting airway irritants and the neural pathways mediating cough share similarities with those that encode pain from the body. Painful conditioning stimuli applied to one body site are known to reduce the perception of pain at another. However, whether the neural regulation of cough is influenced by painful stimuli is not known. RESEARCH QUESTION: What are the behavioral and neural outcomes of painful conditioning stimuli on urge-to-cough (UTC) and cough evoked by inhaled capsaicin? STUDY DESIGN AND METHODS: Sixteen healthy participants underwent psychophysical testing and functional MRI while completing a series of capsaicin inhalations to induce UTC and cough. The responses associated with capsaicin inhalation without pain were compared with those after the application of painful conditioning stimuli. RESULTS: Significant decreases were seen behaviorally of 18.7% ± 17.3% (P < .001) and 47.0% ± 30.8% (P < .001) in participants' UTC ratings and cough frequencies, respectively, during the application of pain. UTC ratings were reduced by 24.2% ± 36.5% (P < .005) and increased by 67% ± 40% (P < .001) for capsaicin and saline inhalation, respectively, during the scanning session. Painful conditioning stimuli were associated with widespread decreases in regional brain responses to capsaicin inhalation (P < .001). Several brain regions showed levels of reduced activation attributable to painful conditioning that correlated with related changes in behavioral responses during scanning (R2 = 0.53). INTERPRETATION: Pain-related decreases of cough and UTC are accompanied by widespread changes in brain activity during capsaicin inhalation, suggesting that pain can modify the central processing of inputs arising from the airways. A mechanistic understanding of how cough and pain processing interact within the brain may help develop more effective therapies to reduce unwanted coughing.

Following the emergence of COVID-19 outbreak, numbers of studies have been conducted to curtail the global spread of the virus by identifying epidemiological changes of the disease through developing statistical models, estimation of the basic reproduction number, displaying the daily reports of confirmed and deaths cases, which are closely related to the present study. Reliable and comprehensive estimation method of the epidemiological data is required to understand the actual situation of fatalities caused by the epidemic. Case fatality rate (CFR) is one of the cardinal epidemiological parameters that adequately explains epidemiology of the outbreak of a disease. In the present study, we employed two statistical regression models such as the linear and polynomial models in order to estimate the CFR, based on the early phase of COVID-19 outbreak in Nigeria (44 days since first reported COVID-19 death). The estimate of the CFR was determined based on cumulative number of confirmed cases and deaths reported from 23 March to 30 April, 2020. The results from the linear model estimated that the CFR was 3.11% (95% CI: 2.59 – 3.80%) with R2 value of 90% and p-value of < 0.0001. The findings from the polynomial model suggest that the CFR associated with the Nigerian outbreak is 3.0% and may range from 2.23 to 3.42% with R2 value of 93% and p-value of, Highlights • The linear and polynomial regression models were applied to the early spread of SARS-CoV-2 in Nigeria. • From both models, we estimated the case fatality rate (CFR) of the virus. • We found that the estimated CFR associated with the outbreak are 3.11% (95% CI: 2.59 –3.80%) and 3.0% (95% CI: 2.23–3.42%) for the linear and polynomial models respectively. • The polynomial regression model with the higher R 2 value fits the dataset well and provides better estimate of CFR for the reported COVID-19 cases in Nigeria.

Four diets containing 16% crude protein were formulated with varying levels of groundnut haulms (GNH) and cowpea shell (CPS). The diets designated as Diets 1, 2, 3 and 4, contained 60% GNHI 0% CPS; 40% GNH/20% CPS, 20% GNH/40% CPS and 0%GNH/60%CPS respectively. The diets were fed to sixteen kids of Red Sokoto goats (two males and two females per diet] for seventy days in order to study the effects of varying levels of GNH and CPS on feed intake, nutrient digestibilities and weight gains of the animals. The results showed that the highest dry matter and crude protein intakes by the animals obtained for Diet 2 were 477.30 g/ day and 77. 85g/ day respectively. The lowest water intake per kilogram dry matter intake was obtained on Diet 3 (2. 421). Animals on Diet 2 had a better daily weight gain (85.41g/ day) compared to those on the other diets. The highest feed conversion ratio was obtained on Diet 4 (7.35). Nutrient digestibilities were significantly (p

Background: Group B Streptococcus (GBS) is a major cause of bacterial infections in the perinatal period, of which colonization prevalence among Northern-Nigerian pregnant women is scarce. We attempted to determine 1) its prevalence, 2) risk factors for GBS colonization and 3) drugs-susceptibility. Methodology: This cross-sectional study involved 185 pregnant women between 35 - 37 weeks of gestation at tertiary health center of Sokoto, Nigeria. Vaginal/rectal swabs were collected, were cultured for GBS and tested for drug-susceptibilities. The study was conducted between December, 2017 and April, 2018. Results: One hundred and eighty five (185) pregnant women participated in this study. GBS vaginal-colonization-rate was 3.8% (7/185). A significance relationship was observed between GBS-colonization and socio-economic class, as 57.10% (4/7) of the GBS positive women were of low-socio economic class (p 0.035). No associations were observed between GBS-colonization and the followings: maternal age, parity, poor obstetric outcome-history. All the 7 GBS positive cultures were sensitive to Clindamycin. One was sensitive to both Clindamycin and Ceftriaxone. None was sensitive to Penicillin. Conclusion: The prevalence of GBS colonization was low in this area. Maternal socio-economic class is found to be a risk of GBS-colonization.

Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland or Fishman syndrome, is an extremely rare congenital neurocutaneous disorder that characteristically involves ectomesodermal tissues such as the central nervous system, eyes, and skin. The etiology of the disease remains unknown. Here we present a rare case of ECCL associated with bilateral eye involvement and orbital cyst from Sub-Saharan Africa. A 3-year-old boy presented with cystic right eye swelling since birth. Physical examination showed alopecia on right side of the scalp, ipsilateral ocular cyst, and microphthalmia with a contralateral limbal dermoid. Computed tomography of the brain revealed severe atrophy of the right cerebral hemisphere with an expansion of the cerebrospinal fluid space and dilatation of the lateral ventricle suggesting ex-vacuo hydrocephalus. Right orbital cyst continuous with the globe and calcification of the posterior aspect of both globes were also present. Histopathologic findings of the excised orbital cyst revealed an eyeball covered by fatty tissue, calcification of the cyst wall, and corneal opacity. Microscopy showed cornea-sclera wall composed of normal cartilage communicating with sandwich bony trabeculae with a focus of marrow cells, consistent with choristoma. The constellation of these findings conforms to Moog’s revised diagnostic criteria for ECCL proposed in 2009. Although the disorder is easily recognizable at birth, neuroimaging is essential for appropriate diagnosis and management and to exclude or confirm other unusual associated abnormalities.

Purpose Boreout is a psychological state of intense boredom and apathy. Characterized by the absence of mental stimuli (i.e. menial tasks) required to keep employees conscious about their environment, and this incessant decline in mental stimuli may turn employees into “professional zombies.” The diversity in work needs and preferences across generations has become a key organizational factor, generational differences have been studied in Western countries, not much information is available about generational cohorts and satisfaction (i.e. career, life and job satisfaction) in developing countries. The purpose of this paper is to provide more insights on these phenomena. Design/methodology/approach Drawing upon conservation of resources theory, this paper examines the potential effects of boreout on important job outcomes (i.e. career, life and job satisfaction) conditioned by generation (Gen-Xers and Gen-Yers) in the service industry. Data analyses with Artificial Intelligence technique (i.e. artificial neural network) and structural equation modeling were conducted with data collated from Nigerian service employees. Findings Results revealed that boreout has a negative impact on career, life and job satisfaction. The hypothesized relationships were significantly moderated by generation cohorts as Gen-Xers and Gen-Yers were found to be distinct cohorts. Originality/value This paper advocates that non-western organizations should avoid utmost service standardization and rigid stylization of work processes and procedures.

The study was carried out to determine the prevalence and antimicrobial sensitivity pattern of enteric bacteria isolated from food handlers within Bells University of Technology, Ota, Ogun State. Stool samples from thirty-five food handlers were collected. The samples were cultured on Salmonella-Shigella agar and MacConkey agar and growth was observed in all samples. The organisms isolated were Salmonella species (8.6%), Escherichia coli (8.6%), Proteus vulgaris (51.4%), Citrobacter freundii (8.6%), Staphylococcus saprophyticus (8.6%), Providencia sp. (2.9%), and Enterococcus sp. (17.1%). The most prevalent of these organisms is Proteus vulgaris and the least prevalent of these organisms is Providencia sp. Antibiotic sensitivity test showed that majority of the isolates in this study were sensitive to ofloxacin, augmentin, nitrofurantoin, ciprofloxacin, ceftazidime and gentamicin, and showed various degree of sensitivity to cefuroxime. While most of the isolates were resistant to cefixime. Based on the result antibiotics such as gentamicin, augmentin, and ofloxacin are most efficient for the diseases that can be caused by these isolated enteric bacteria while previously use antibiotic such as cefixime was poorly effective against majority of the isolates in this study. Health education along with continuous food safety training should be given to food handlers so as to adhere to effective hygienic practices which can help in preventing transmission of these enteric bacteria to the consumers. Keywords: Antibiotic sensitivity, Asymptomatic, Food contamination, Food handlers

This study focused on the dynamics of Maternal Health Services utilization in Kebbi State using a Systems Thinking approach. The broad objective was to understand the effect of interventions intended to promote utilization of Maternal Health Services. The study evolved a model to represent the causal interrelationship, interdependencies and feedback influences of the multifactorial and multisectoral public health approach on utilization of public maternal health services using a Systems Thinking approach. This enabled us draw inferences on the effect on the mother, the intended end-beneficiary from these interventions. Using a Causal Loop Diagram, we were able to identify reinforcing and balancing feedback loops that could explain the behavior or outcomes being observed. The findings revealed that the feedback in the system is driven by limited resources at the household levels, technical quality of health care services, and knowledgeableness of women on maternal health services. From this, we were able to recommend that policy-makers should try to effectively address socio-economic inadequacies at the household level including socio-cultural practices leading to low level of girl-child school enrolment, and several factors affecting motivation of health care workers. While efforts to ensure quality of care and community awareness should be maintained, emphasis and priority needs to be given to interventions that target economic improvements of households.

Clerodendrum capitatum (Willd) Schumach and Thonn. (Verbenaceae) is a perennial herb, which grows up to 0.5 m to 2 m high. It is widespread over North-East, East, and South Central Africa. It is known as “bambaro or maashayi” by the Hausas of Northern Nigeria. The leaves are used traditionally to treat intercostal pain, headaches and toothaches. The aim of this study is to evaluate the anti-inflammatory and analgesic activities of the aqueous ethanol extract and fractions of C. capitatum. The anti-inflammatory activity was investigated using carrageenan induced rat paw oedema model, while acetic acid induced mice writhing model was used to evaluate the anti-nociceptive property. The oral median lethal dose values were found to be greater than 5,000 mg/kg for the aqueous ethanol extract, ethyl acetate and n-butanol fractions, while that of dichloromethane fraction was less than 2000 mg/kg using OECD method. The acetic acid induced writhing was significantly (P

General anaesthesia is known to be associated with the risk of cardiopulmonary depression, therefore the use of a safer means of anaesthesia as an alternative has to be explored. Epidural anaesthesia technique is known for its simplicity, safety and effectiveness and is one of the most frequently used regional anesthetic techniques described for surgical procedures caudal to the umbilicus in small animal practice. The main aim of this study was to evaluate the effects of lumbo-sacral epidural injection of a mixture of 7.5 mg/kg of 2% lignocaine solution and 0.2 mg/kg 0.5% diazepam solution in 10 apparently healthy Nigerian local dogs undergoing caudectomy. Onset of neural blocked recorded was 6.5 ± 1.35 min (mean ± SD), duration of analgesia was 54.4 ± 5.38 min (mean ± SD) and duration of recumbency was 115.1 ± 36.1min (mean ± SD). Changes observed in the Pulse rate (PR), Mean arterial blood pressure (MAP), Respiratory rate (RR) and Rectal temperature (RT) were recorded at 10 min intervals throughout the duration of the procedure. There were no significant differences (p>0.05) in the mean physiological parameters observed as compared to the baseline values. Blood samples were also taken at 15 min interval throughout the duration of the procedure to determine the effects of the epidurally administered lignocaine-diazepam combination on haematological and serum biochemical indices. No significant differences (p>0.05) were observed in the mean haematological (PCV, RBC, WBC, Hb and CBC) and serum biochemical indices (ALT, ALP, Creatinine and BUN). It was concluded that epidurally administered lignocaine-diazepam mixture at 7.5 mg/kg and 0.2 mg/kg respectively had a fast onset of neural blockade, adequate and long duration of analgesia without profound effects on haemodynamic and cardiopulmonary system.

Objective: Good nutrition is important in promoting health and is dependent on the quality of food eaten. Little has been researched on the dietary practices among the workforce in Nigeria. This study aimed at assessing the dietary knowledge, practices, and factors influencing dietary practices and work productivity among the non-medical staff of Universities. Methods: This is a descriptive cross-sectional survey of 398 non-medical staff of Babcock University who were selected using the multi-stage sampling technique. Data were analyzed using the Statistical Package for Social Sciences (SPSS 21) to compute frequency distributions, means, and standard deviations. Nutritional knowledge, dietary practices, and barriers to work productivity were assessed. Inferential statistical analysis was conducted using Pearson’s correlation coefficient. Results: The mean age among respondents was 38.68±11.04, with the majority being female 54.6%. of the respondents (61.1%) of Yoruba origin, about three percentiles (66%) were members of staff while (34%) were faculty members. The computed level of knowledge and dietary-based practices scores were (2.57±0.61) and (3.64±1.44) respectively, indicating poor knowledge and dietary practices, while the barriers that influence work productivity among workers (11.34±5.286) were high at 87.2%. No significant association was found between nutritional knowledge and dietary practices of staff and faculty (p=.154), but a significant association was found between dietary practices and work productivity of staff and faculty (p=.019) Conclusion: Health education and promotion of good nutrition should be incorporated in the workplace, interventions that will improve work productivity among workers are also encouraged. This will culminate in a well-fed and healthy workforce.

Elevated liver enzymes are commonly seen by paediatricians in clinical practice. For many clinicians, interpreting deranged liver enzymes can be challenging. There is a lack of an evidence based approach to this. Alterations in liver enzymes may be a normal physiological response to an intercurrent illness or in certain cases may also reflect an underlying liver condition. In this review, we will aim to provide, through a series of cases, a guide on the approach of deranged liver enzymes to conditions that health care professionals may ‘commonly’ encounter.

The study was undertaken to investigate the histological and functional relationships between the pons and Medulla Oblongata of African Striped Ground Squirrel (Xerus erythropus). Twenty (20) adult African striped ground squirrels were divided in to two groups: 10 males and 10 females. The ground squirrels were obtained from the surrounding villages of Zaria Local Government, Kaduna State Nigeria. Each Squirrel was euthanized using ketamine hydrochloride at dose 80mg/kg BW followed by gentle perfusion with neutral formal saline. A pair of scissors, chisel and scalpel blade was used to gently extract the brain (craniotomy). The extracted brain was fixed in bouins solution for 24hours and processed histologically. The pons and medulla are composed of conspicuous nucleus abducens, nucleus facialis and nucleus trigeminal. The nucleus facialis was found dorsal to the paramedian pontine reticular formation as group of large multipolar neurons. A conspicuous nucleus abducens was found as clusters of medium neurons located lateral to the trigeminal nucleus. In myelencephalon, the cuneate fascicles, intermediate sulcus and lateral sulcus were not evident on dorsal surface but there were grossly visible pyramids and olivary prominence on the ventral surface. Similarly, the nucleus olivary were prominent, nucleus cochlearis and spinal nucleus trigemini were well developed, nucleus hypoglossi, raphe obscurus, lateral reticular nucleus, gigantocellular reticular nucleus were all very distinct. In conclusion, the presence of distinct nuclei in the pons and medulla oblongata gives squirrels fine voluntary skills with good motor coordination and balance and good visual acuity for improved diurnal adaptation.

In this study, assessment of outdoor background exposure levels in some selected swampy agricultural soil in Nasarawa West, Nigeria has been conducted. An in-situ measurement of outdoor background exposure rate (in mRhr-1) for a total of fifty farms (ten each from Keffi (KF), Kokona (KK), Karu (KR), Toto (TT), and Nasarawa (NS)) were done using a well calibrated portable halogen-quenched Geiger Muller (GM) detector (Inspector alert Nuclear radiation monitor SN:3544). A geographical positioning system (GPS) was used at an elevation of 1.0 m above ground level to obtain the geographical location. The radiological hazard parameters were evaluated using the measured outdoor background exposure rates. The values obtained were compared with recommended permissible limits to ascertain the radiological hazard status of the swampy agricultural farms. The mean values of the outdoor background exposure levels (0.23, 0.038, 0.028, 0.022, and 0.039 mRh-1), absorbed dose rates (458.49, 334.95, 188.79, 194.01, and 343.65 nGyh-1) and excess lifetime cancer risk (1.968, 1438, 0.810, 0.832, and 1.475) each for KF, KK, KR, TT, and NS respectively, are higher than the recommended safe limits of 0.013 mRh-1, 84.0 nGyh-1, 0.00029 respectively as recommended by UNSCEAR and ICRP. On the other hand, the mean annual effective dose equivalent (AEDE) values (0.563, 0.410, 0.232, 0.238, and 0.421 mSvy-1 for KF, KK, KR, TT, and NS respectively) are below the recommended permissible limits of 1.00 mSvy-1 for general public exposure. Generally, the study revealed that swampy agricultural soils in Nasarawa west are radiologically safe with little contamination which could be attributed to the geological formation and partly due to human activity in the area.

The International Endocervical adenocarcinoma Criteria and Classification (IECC) categorizes tumors into human papilloma virus (HPV) associated (HPVA), not associated (NHPV), and invasive adenocarcinoma not otherwise specified (IA NOS). HPVA and NHPV encompass 11 histotypes and an algorithm of mucin content, HPV ribonucleic acid (RNA), estrogen receptor and GATA3 is proposed for the diagnosis of most. In this study, the IECC algorithm's diagnoses were compared with hematoxylin and eosin (H&E) based IECC histotyping. Kappa statistics measured performance agreement. With additional markers, hierarchical clustering by random forest (RF) classification identified the most discriminating between tumor types, and investigated other algorithms. Three pathologists independently reviewed digitized H&E images of n=152 primary cervical adenocarcinomas for IECC histotype and mucin content, and tissue microarrays for expression of HPV RNA by in situ hybridization and 16 antibodies by immunohistochemistry. Results were finalized by consensus. There were n=113 HPVA, n=22 NHPV, and n=17 IA NOS. Mucin was obvious in n=36 and limited in n=116. Among n=124 with satisfactory test results, HPV RNA was positive in n=96, estrogen receptor in n=72, and GATA3 in n=15. The IECC algorithm diagnosed n=99 which agreed with H&E histotyping in n=64 for a fair κ of 0.36 (95% confidence interval, 0.21-0.50): n=12 were undiagnosed and n=13 were IA NOS. Small sample sizes restricted RF to HPVA versus NHPV which were discriminated by p16, HPV RNA, and MUC6 with an area under the curve of 0.74 (95% confidence interval, 0.58-0.90). The IECC algorithm for histotyping under-performed. The RF algorithmin for categorization was favorable, but validation in larger studies and investigation of additional algorithms to discriminate between all IECC histotypes are needed.

Indonesia is one developing country with vary of social and culture forms, especially in Eastern part. As the vulnerable group, women of reproductive age are still facing the malnutrition, including anemia. This study aimed to examine the determinants of severity of anemia and BMI (Body Mass Index) level among anemic women. Methods: This study used the secondary data IFLS East (Indonesia Family Life Survey East) with totally 1,021 anemic women as a sample based on sampling method of SUSENAS 2010. The sample has been chosen by multi-stage random sampling with completeness of hemoglobin, weight, and height data. The dependent variables are level of anemia and level of BMI. This study tested for the univariate, bivariate (chi-square), and multivariate (ordinal logistic regression) by using STATA software. Results: The determinants of severity of anemia are BMI (AOR 1,32), place of resident (AOR 0,73), pregnancy status (AOR 0,22), and involvement in community activity (AOR 0,64). The determinant of BMI is anemia status (AOR 0.53), place of resident (AOR 0,46), educational level (AOR 0,46), pregnancy status (AOR 7,76), breastfeeding status (AOR 2,.54), ethnicity (AOR 2,42), being a Protestant (AOR 1,62), being a Chatolic (AOR 2,31), miscarriage history (AOR 5,05), and egg consumption (AOR 1,50). Conclusions: Pregnancy status is the strongest variables related to severity of anemia and pregnancy status, breastfeeding status, and ethnicity are the strongest variables related to BMI.

Background Survivors of invasive group B Streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopmental impairment. However, the limited studies to date have a median follow-up to 18 months and have mainly focused on moderate or severe neurodevelopmental impairment, with no previous studies on emotional-behavioral problems among iGBS survivors. Methods In this multicountry, matched cohort study, we included children aged 18 months to 17 years with infant iGBS sepsis and meningitis from health demographic surveillance systems, or hospital records in Argentina, India, Kenya, Mozambique, and South Africa. Children without an iGBS history were matched to iGBS survivors for sex and age. Our primary outcomes were emotional-behavioral problems and psychopathological conditions as measured with the Child Behavior Checklist (CBCL). The CBCL was completed by the child’s primary caregiver. Results Between October 2019 and April 2021, 573 children (mean age, 7.18 years) were assessed, including 156 iGBS survivors and 417 non-iGBS comparison children. On average, we observed more total problems and more anxiety, attention, and conduct problems for school-aged iGBS survivors compared with the non-iGBS group. No differences were found in the proportion of clinically significant psychopathological conditions defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Conclusions Our findings suggested that school-aged iGBS survivors experienced increased mild emotional behavioral problems that may affect children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioral assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted.

The COVID-19 pandemic has put severe pressure on health care systems worldwide. Although attention has been focused on COVID-19 hospitalizations and deaths, some experts have warned about potentially devastating secondary health effects. These effects may be most severe in low- and middle-income countries with already weak health care systems. This study examines the effect of the COVID-19 pandemic on early infant deaths, a question that is currently unsettled. We present new evidence from Nigeria showing that early infant deaths have significantly increased during the pandemic. Using data on the birth outcomes of a large and diverse cohort of pregnant women enrolled in a prospective study and a quasi-experimental difference-in-differences design, we found a 1.1-percentage-point (22 percent) increase and a 0.72-percentage-point (23 percent) increase, respectively, in stillbirths and newborn deaths. Our findings show that the health effects of the pandemic extend beyond counted COVID-19 deaths. If these findings generalize to other low- and middle-income countries, they may indicate that the hard-won gains in child survival made during the past two decades are at risk of being reversed amid the ongoing pandemic. Policies addressing disruptions to health services delivery and providing support to vulnerable groups-specifically to households with pregnant women-will be critical as the pandemic continues.

Background Elevated mammographic breast density is a strong breast cancer risk factor with poorly understood etiology. Increased deposition of collagen, one of the main fibrous proteins present in breast stroma, has been associated with increased mammographic density. Collagen fiber architecture has been linked to poor outcomes in breast cancer. However, relationships of quantitative collagen fiber features assessed in diagnostic biopsies with mammographic density and lesion severity are not well-established. Methods Clinically indicated breast biopsies from 65 in situ or invasive breast cancer cases and 73 frequency matched-controls with a benign biopsy result were used to measure collagen fiber features (length, straightness, width, alignment, orientation and density (fibers/µm2)) using second harmonic generation microscopy in up to three regions of interest (ROIs) per biopsy: normal, benign breast disease, and cancer. Local and global mammographic density volumes were quantified in the ipsilateral breast in pre-biopsy full-field digital mammograms. Associations of fibrillar collagen features with mammographic density and severity of biopsy diagnosis were evaluated using generalized estimating equation models with an independent correlation structure to account for multiple ROIs within each biopsy section. Results Collagen fiber density was positively associated with the proportion of stroma on the biopsy slide (p p = 0.035) and within a 2 mm perilesional ring (p = 0.02), but not with global mammographic density measures. As severity of the breast biopsy diagnosis increased at the ROI level, collagen fibers tended to be less dense, shorter, straighter, thinner, and more aligned with one another (p Conclusions Collagen fiber density was positively associated with local, but not global, mammographic density, suggesting that collagen microarchitecture may not translate into macroscopic mammographic features. However, collagen fiber features may be markers of cancer risk and/or progression among women referred for biopsy based on abnormal breast imaging.

Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS). They quickly diffuse through the blood–brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. One of the debilitating side effects of BZDs is their addictive potential. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Some of these withdrawal symptoms can be life threatening. The current treatment for withdrawal is through tapering with clonazepam. Many drugs have been tested as a treatment for withdrawal, with few proving efficacious in randomized control trials. Future research is warranted for further exploration into alternative methods of treating BZD withdrawal. This call to action proves especially relevant, as those seeking treatment for BZD dependence and withdrawal are on the rise in the United States.

Objective: To identify the prognostic factors in relapsed Hodgkin’s Lymphoma patients with regards to their impact on the outcome of autologous hematopoietic stem cell transplant. Study Design: Retrospective observational study. Place and Duration of Study: Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Jun 1999 to Jun 2019. Methodology: Out of a total of 2061 Hodgkin’s Lymphoma patients, 37 (1.8%) patients with relapsed disease underwent autotransplant and were studied using the Hospital Information System. We obtained details of clinicopathological factors, treatment, and outcome. In our study, the outcome variable was event after transplant (relapse/disease progression/death). Results: Among the 37 relapsed Hodgkin’s Lymphoma patients undergoing auto-transplant, 24 (64.9%) patients had an early relapse after first-line chemotherapy. In this early relapse group of 24 patients, 9 (37.5%) remained well after auto-transplant but 15 (62.5%) patients had an event. Out of 37 relapsed Hodgkin’s Lymphoma patients undergoing auto-transplant, a complete response on pre-transplant imaging was observed in 24 (64.9%) patients. In those 24 patients with a complete response on pre-transplant imaging, 16 (66.7%) patients remained well after transplant while 8 (33.3%) patients had a worse event. Twoyear progression-free and overall survival proportions were 56% and 77% respectively. Conclusion: Complete metabolic response on pre-transplant imaging was associated with better overall survival. Adverse factors observed were initial short duration of complete response, bulky disease at relapse, variables comprising international prognostic score, B symptoms, and raised erythrocyte sedimentation rate at relapse.

Typhoid perforation is still prevalent in children in developing countries. Hence, the need for a review of the morbidity and mortality from typhoid perforation in children from poor countries. We review the clinical features, morbidity, and mortality of typhoid perforation in children aged ≤ 5 years in a developing country. A retrospective 10-year study of children aged ≤ 5 years with typhoid perforation in two tertiary hospitals in northeastern Nigeria. Data regarding clinical presentation, investigations, intra-operative findings, treatment, and outcome were reviewed. Out of 221 children aged ≤ 15 years with typhoid perforation, 45 (20.4%) were aged ≤ 5 years. Fever and abdominal distension were present in all 45 (100.0%), followed by abdominal pain 33 (73.3%), constipation 19 (42.2%), diarrhoea and vomiting 18 (40.0%) and vomiting 13 (28.8%). All patients presented in second week of infection. Plain abdominal radiograph showed pneumoperitoneum suggestive of bowel perforation in 39 (86.7%) patients. Forty-one (91.1%) patients had ileal perforations with various severities of peritonitis. Out of which, 30 (73.2%) were single and 11 (26.8%) were multiple perforations. Two (4.4%) patients had peritonitis without bowel perforation, while 2 (4.4%) others had caecal, gall bladder perforations, respectively. Serious post-operative wound complications occurred in patients with severe peritonitis, multiple perforations, prolonged pre-operative resuscitation, and operation beyond 2 h. Overall, mortality rate was about 26.7% mainly in patients who had multiple perforations, severe peritonitis, prolonged pre-operative resuscitation, and operation time more than 2 h. Multiple perforations, severe peritonitis, and operation time more than 2 h are poor post-operative factors that were associated with poor post-operative outcome in our patients.

The paper evidenced that Hepatitis B infection is the world's deadliest liver infection and Vaccination is among the principal clinical strategies in fighting it. These have encouraged a lot of researchers to formulate mathematical models to accurately predict the mode of transmission and make deductions for better health decision-making processes. In this paper, an SEIR model is used to model the transmission of the Hepatitis B infection with periodic contact rate and examine the impact of vaccination. The model was validated using estimated data in Ghana and simulated in a MATLAB environment. The results showed that the vaccination rate has a great impact on the transmission mode of the Hepatitis B infection and the periodic contact rate may lead to a chaotic solution which could result in an uncontrolled spreading of the infection. It is concluded that even if the vaccination rate is 70%, the infection rate would reduce to the minimum barest so more newborns must be vaccinated.

In this study, the monthly average minimum and maximum temperature meteorological data obtained from the European Centre for Medium-Range Weather Forecasts (ECMWF) during the period of thirty eight years (1979 – 2016) were used to estimate the mean velocity and most probable velocity of atomic Oxygen and Hydrogen for Ilorin. The values of the mean velocity and most probable velocity for these atoms were compared to the value of escape velocity. The results revealed that the highest values of mean velocity and most probable velocity for atomic Oxygen were found to be in the month of March with and respectively and the highest values of mean velocity and most probable velocity for atomic Hydrogen were found to be in the month of March with and respectively. Based on the values of the mean velocity and most probable velocity for atomic Oxygen and Hydrogen obtained during the studied period suggests that these atoms cannot escape the gravitational field as their values are less than the escape velocity .

Background: Traction alopecia (TA) is the commonest cause of hair loss among women, with a prevalence of 46.2% in Nigeria. Adequate knowledge and good hair care practices can assist in its prevention. Objective: The aim of this study was to determine knowledge of both TA and hair care practices among adolescents in Keffi, Nigeria. Methods: This was a cross-sectional survey conducted among 333 female adolescents in 3 senior secondary schools between November 2019 and February 2020. The participants were randomly selected and interviewed using a questionnaire which sought information about the knowledge of TA and hair care practices. The data were analysed using SPSS 25 statistical software. Results: Overall, the knowledge score was poor in 61.4% of the adolescents. Hair plaiting 86.8% (289/333), use of chemical relaxers 68.8% (229/333), and use of hair covers 88.3% (294/333) were the predominant hair care practices. In total, 90.8% had concurrently relaxed and plaited their hair. Cornrows with own hair were the commonest hair grooming style. The use of hair attachments was believed to be the commonest cause of TA. The use of hijab was the commonest form of hair cover used. Conclusions: The knowledge of TA is poor among female adolescents. A large number engaged in risky hair care practices. Interventions to reduce the knowledge gap will reduce the prevalence of TA. Key Message: The knowledge of traction alopecia is poor among female adolescents in Keffi who engage in traumatic hair practices.

Osmotic stress, oxidative stress and oxidation of essential macromolecules are common consequences of salinity stress that limit plant growth and productivity. Plants are known to evolve several strategies such as upsurge of antioxidant defence systems (ADS) and accumulation of osmolytes, so as to thrive under such conditions. In the present study, the effect of salinity stress (using irrigation method) on ADS of two cultivars (IT-99 and IT-288) of cowpea was examined. Plant samples (roots, young leaves and matured leaves) were harvested on day 21 of treatment with saline solution (100 – 400 mM NaCl). Antioxidant markers and osmolytes levels were quantified and compared with the controls (0.0 mM NaCl). The activities of superoxide dismutase, catalase, peroxidase and ascorbate peroxidase significantly increased (p0.05) different in all the salinity levels investigated. The level of proline increased at moderate salinity levels in all samples and at high salinity in roots of IT-99 and mature leaves of IT-288. For IT-99, levels of glycinebetaine significantly increased (p

The tumor microenvironment (TME), including immune cells, cancer‐associated fibroblasts, endothelial cells, adjacent normal cells, and others, plays a crucial role in influencing tumor behavior and progression. Here, we characterized the TME in 83 primary renal tumors and matched metastatic or recurrence tissue samples (n = 15) from papillary renal cell carcinoma (pRCC) types 1 (n = 20) and 2 (n = 49), collecting duct carcinomas (CDC; n = 14), and high‐grade urothelial carcinomas (HGUC; n = 5). We investigated 10 different markers of immune infiltration, vasculature, cell proliferation, and epithelial‐to‐mesenchymal transition by using machine learning image analysis in conjunction with immunohistochemistry. Marker expression was compared by Mann–Whitney and Kruskal–Wallis tests and correlations across markers using Spearman's rank correlation coefficient. Multivariable Poisson regression analysis was used to compare marker expression between histological types, while accounting for variation in tissue size. Several immune markers showed different rates of expression across histological types of renal carcinoma. Using pRCC1 as reference, the incidence rate ratio (IRR) of CD3+ T cells (IRR [95% confidence interval, CI] = 2.48 [1.53–4.01]) and CD20+ B cells (IRR [95% CI] = 4.38 [1.22–5.58]) was statistically significantly higher in CDC. In contrast, CD68+ macrophages predominated in pRCC1 (IRR [95% CI] = 2.35 [1.42–3.9]). Spatial analysis revealed CD3+ T‐cell and CD20+ B‐cell expressions in CDC to be higher at the proximal (p

BACKGROUND: Data on non‐motor symptoms (NMS) in black Africans with Parkinson's disease (PD) are sparse. OBJECTIVE: To describe the profile of NMS in the Nigeria PD Registry (NPDR) cohort and explore the relationship between NMS and PD motor phenotype. METHODS: We conducted a cross‐sectional study of the frequency and burden of NMS, based on the non‐motor symptoms scale (NMSS) and the Chaudhuri method respectively in our cohort. Baseline demographics, disease characteristics (Hoehn and Yahr stage, MDS‐UPDRS total score and Part III motor score), motor phenotype (based on Stebbin et al's algorithm), and levodopa equivalent daily dose (LEDD) were documented. RESULTS: Data are presented for 825 PD whose mean age at study was 63.7 ± 10.1 years, female sex—221 [26.8%] while median PD duration was 36 months. PD phenotypes included tremor‐dominant 466 (56.5%), postural instability and gait disorder (PIGD) 259 (31.4%), and indeterminate 100 (12.1%). 82.6% were on treatment (median LEDD of 500 mg/24 hours). 804 (97.5%) endorsed at least 1 NMS. The median NMSS score was 26.0 while subscores for urinary and sexual function domains were significantly higher in males (P