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Abstract Tracheal stenosis is a common complication of endotracheal intubation or tracheostomy, resulting in significant morbidity and mortality. Bronchoscope interventions have been proposed as a safe alternative for the management of post‐intubation post‐intubation tracheal stenosis (PITS). Data for patients diagnosed with PITS across two hospitals, between 2021 and 2022, encompassing demographic, clinical, and procedural details were gathered from electronic medical records, and analysed. Primary outcomes centred on assessing the incidence and severity of PITS through bronchoscope examination and radiological imaging, and the efficacy of bronchoscope interventions, including stenting and the application of mitomycin C. Twelve patients were managed for PITS. Majority of patients were females (9/12) with mean age of 46.41 years. Presenting signs and symptoms were dyspnea, rhonchi and failed extubation, the mean duration of intubation/ tracheostomy is 16.41 days (range: 3–40 days). Most common comorbidity was type 2 diabetes, (5 patients, 41.6%). The lesions mean length was 3.09 cm and Cotton‐Meyer Grade II and III. Prompt evaluation is crucial, in these patients. The Cotton‐Meyer grade is pivotal in treatment decisions, with intubating times correlating with the severity of stenotic disease. Our case series demonstrates the increasing utility of bronchoscopy in managing these cases.

Abstract There is limited data on the use of benralizumab in patients with severe asthma, who have allergic bronchopulmonary aspergillosis (ABPA). We report the case of a 65‐year‐old woman with combined severe eosinophilic and allergic asthma, who presented with refractory respiratory symptoms, hypereosinophilia and high immunoglobulin E (IgE) level. The patient had consistently poor Asthma Control Test (ACT) scores, despite a maximum dose of inhalation therapy. Upon further investigations, she was diagnosed with concomitant ABPA. The patient was started on oral prednisolone and itraconazole, but her symptoms persisted. She was then started on subcutaneous omalizumab, but switched to benralizumab after developing a severe allergic reaction. The patient experienced rapid clinical improvements after the first dose of subcutaneous benralizumab. Benralizumab demonstrated a significant role in reducing the exacerbation rate and oral corticosteroid use in this patient, as well as improving lung function, asthma control, and quality of life measures.

Background: Violence against women has been reported to be high across Nigeria. However, there are no specific data on this issue across individual states in southwestern Nigeria and their correlations. This study aimed to characterize the types, prevalence, and correlates of violence against reproductive-age women in the southwestern Nigeria states, thereby establishing an inter-state comparison that could stimulate a community-based intervention.Methods: This cross-sectional study was a secondary data analysis of the population-based 2018 Nigerian Demographic and Health Survey (NDHS) data. The NDHS collected data from 14th August to 29th December 2018 through a stratified three-stage cluster sample design using a sampling frame containing the list of enumeration areas prepared for 2006. Responses from 1516 women aged 15-49 were analyzed by descriptive and inferential statistics in SPSS version 25.Results: The overall percentage of intimate partner violence (IPV) was 22% (95% CI=19.9%-24.2%) and 17% (14.7%-18.5%) for non-IPV. Oyo State had the least percentage of IPV (11%) while Lagos State had the highest (25%). Women from Ogun State had a statistically significant risk of non-IPV, such that 47% of people with non-IPV came from the state (P=0.001). The odds of IPV among women with secondary education (OR=1.78, CI=1.25-2.55; P=0.002) was more than that of women with primary education (OR=1.68, CI=1.10-2.56; P 0.016). Alcohol consumption and husband’s controlling behavior were the most important predictors of IPV across the states (P

Tracheal stenosis is a common complication of endotracheal intubation or tracheostomy, resulting in significant morbidity and mortality. Bronchoscope interventions have been proposed as a safe alternative for the management of post‐intubation post‐intubation tracheal stenosis (PITS). Data for patients diagnosed with PITS across two hospitals, between 2021 and 2022, encompassing demographic, clinical, and procedural details were gathered from electronic medical records, and analysed. Primary outcomes centred on assessing the incidence and severity of PITS through bronchoscope examination and radiological imaging, and the efficacy of bronchoscope interventions, including stenting and the application of mitomycin C. Twelve patients were managed for PITS. Majority of patients were females (9/12) with mean age of 46.41 years. Presenting signs and symptoms were dyspnea, rhonchi and failed extubation, the mean duration of intubation/ tracheostomy is 16.41 days (range: 3–40 days). Most common comorbidity was type 2 diabetes, (5 patients, 41.6%). The lesions mean length was 3.09 cm and Cotton‐Meyer Grade II and III. Prompt evaluation is crucial, in these patients. The Cotton‐Meyer grade is pivotal in treatment decisions, with intubating times correlating with the severity of stenotic disease. Our case series demonstrates the increasing utility of bronchoscopy in managing these cases. [ABSTRACT FROM AUTHOR]

This pilot study proposes an acoustic study of the vocal expressions in Ìjálá and Ẹ̀sà, two genres of Yorùbá oral poetry. For this study, we conducted an experiment, involving the vocalization of an original poem in speech mode, Ìjálá and Ẹ̀sà. The vocalizations were recorded and analyzed acoustically. The results of the study show that cepstral peak prominence (CPP), Hammarberg index and Energy of voiced sound below 500 Hz distinguish comparisons of Ẹ̀sà, Ìjálá and speech but are not as reliable as F0 height and vibrato. By comparing the pitch trajectories of the speech tones and poetic tunes, we show that poetry determines tone-to-tune mapping but can accommodate language when it is feasible. The results of our investigation are not only in line with the previous impressionistic observations about vocal expression in Yorùbá oral poetry but contribute with new findings. Notably, our investigation supports vocal tremor as the historical origin of vibrato in Ìjálá. As a result of this, we strongly recommend the instruments of phonetic science for the study of vocal expression in African oral poetry.

Phantom tumour, vanishing tumour, and pseudotumour of the lung are terms used to describe the tumour appearance on a chest radiograph of a decompensated heart failure patient, which typically disappears after appropriate treatment of their underlying condition. It is a loculated pleural effusion in the fissures that gives rise to the tumour appearance on the chest radiograph of a patient with heart failure. Its existence might mislead the diagnosis, resulting in unnecessary invasive diagnostic investigations done on the patient. We present a case of a 64 year-old male with multiple co-morbidities presenting with dyspnea, loss of weight, and loss of appetite. A chest radiograph showed homogenous opacity over the right lower zone with cardiomegaly, raising the suspicion of a lung mass apart from heart failure. It disappeared after appropriate diuretic treatment. The computed tomography (CT) thorax, which was planned by the primary team, subsequently showed no lung mass. Hence, a high index of suspicion of phantom tumour is important when a lung mass is noted on a chest radiograph of a patient clinically presented with heart failure. This is because exposure to ionising radiation from CT is completely avoidable with just appropriate treatment of fluid overload. However, CT is still the best modality for assisting physicians in a doubtful case.

Osimertinib is a third-generation thyroxine kinase inhibitor (TKI) used in treating advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation. Osimertinib is used as a second line treatment for patients who develop EGFR T790 M resistance mutation rather than first line due to financial constraints. We present a case of a 60-year-old Chinese gentleman who diagnosed as stage 4 adenocarcinoma with EGFR Exon 19 deletion. His disease progressed after a year of treatment with afatinib. His plasma T790 M was negative and due to delay in tissue biopsy, he was empirically started on osimertinib. However, in view of financial concerns, he opted a dose reduction of 80 mg every alternate day rather than the conventional dose of 80 mg daily. Serial CT Thorax showed partial response based on RECIST 1.1 criteria and he has 9 months of progression free survival. This case report shows that Osimertinib in reduced dose may achieve good partial response and progression free survival in patients.

Relapsing polychondritis (RP) is a rare multisystem condition. Nearly 50% of patients are suffering from airway involvement in RP and it can be fatal. Besides immunotherapies, endobronchial stenting has been found to be useful in the treatment. Insertion of endobronchial stents in patients with RP has it’s own complications and has been associated with increasing morbidity and mortality.We describe placement of multiple endobronchial stents to prevent airway closure in a 76-year-old man with RP due to recurrent dyspnea. Insertion of multiple stents (6th stent) in the left main bronchus was necessary due to severe narrowing of the left main bronchus.Recurrence of airway involvement in RP is common. Early diagnosis and prompt treatment are essential to reduce the risk of life-threatening airway collapse. The insertion of multiple stents in this patient has resulted in improving symptoms, spirometry, and a return to daily activities.

Bio-medical waste (BMW) disposal is a very important but challenging task. Health-care waste contains potentially harmful microorganisms, which can infect hospital patients, health workers, and the general public. Exposure to hazardous health-care waste can result in disease or injury. The Government of India has been laying down rules, namely, Bio-Medical Waste (Management and Handling) Rules, in 1998, The draft of Bio-Medical Waste (Management and Handling Rules 2011,), and recently Bio-Medical Waste Management Rules, 2016. Evidence from different parts of India show that the knowledge on BMW disposal among health-care personnel is low, and the practice of the same is not satisfactory. Strict implementation of the rules laid down is necessary and is the need of the hour.

It has been suggested that the COVID-19 pandemic led to an increase in self-medication practices across the world. Yet, there is no up-to-date synthesized evidence on the prevalence of self-medication that is attributable to the pandemic. This study aimed to conduct a systematic literature review on the prevalence and correlates of self-medication for the prevention and treatment of COVID-19 globally. The review was registered with the PROSPERO database. Searches were conducted following PRISMA guidelines, and relevant articles published between 1 April 2020 and 31 March 2022 were included. Pooled prevalence rate was conducted using the Meta package in R. A total of 14 studies from 14 countries, which represented 15,154 participants, were included. The prevalence of COVID-19-related self-medication ranged from 3.4–96%. The pooled prevalence of self-medication for this purpose was 44.9% (95% CI: 23.8%, 68.1%). Medications reported by studies for self-medication were antibiotics (79%), vitamins (64%), antimalarials (50%), herbal and natural products (50%), analgesics and antipyretics (43%), minerals and supplements (43%), cold and allergy preparations (29%), corticosteroids (14%), and antivirals (7%). The prevalence of self-medication with antibiotics is concerning. More public health education about responsible self-medication amidst the COVID-19 pandemic and future pandemics is required to mitigate the rising threat of antimicrobial resistance.

En los últimos 50 años se ha registrado un aumento gradual de la tasa de envejecimiento de la población uruguaya, reflejándose en un incremento de pacientes con enfermedad renal crónica mayores de 65 años. Este fenómeno plantea la interrogante de cómo el envejecimiento tisular afecta la función del riñón y, en particular cómo contribuye al desarrollo de la fibrosis renal. Con el envejecimiento se producen cambios morfológicos y funcionales en el riñón, tales como la esclerosis glomerular y la fibrosis intersticial. Estos cambios son consecuencia de alteraciones que ocurren a nivel celular. En este trabajo se profundizará en los mecanismos celulares que desencadenan la fibrosis intersticial y la gloméruloesclerosis, describiendo el proceso de inflamación sostenida, la transformación fenotípica de las células epiteliales a miofibroblastos, así como los mecanismos de producción de matriz extracelular y la perpetuación de la fibrosis renal. Además, detallaremos las cascadas moleculares involucradas en el proceso de fibrosis, poniendo énfasis en las cascadas reguladas por TGF-β1 y sus vías de interacción, que regulan la producción factores pro- y anti-fibróticos. También veremos como el TGF-β1 modula la expresión de ARN pequeños no-codificantes (microARNs), potentes inhibidores de la expresión génica, y como el gen anti-envejecimiento Klotho inhibe el avance de la fibrosis renal. Finalmente, discutiremos terapias para frenar o enlentecer el proceso de fibrosis renal, especialmente aquellas que tengan como blanco las cascadas de señalización activadas por TGF-β1, los microRNAs y posibles terapias de activación del gen Klotho para prevenir la progresión de esta patología.

The concepts that where developed in the long­standing practice in designing and constructing tunnels using New Austrian Tunnelling Method (NATM) are presented in the paper. The aim of the paper is to highlight the basic theoretical concepts and to expose the experience in the design and the application of NATM principles following the concrete examples. The procedures used in the application of these principles are also addressed in the paper, in which the active role of the designer and the contractual flexibility between the contractor and the client are seen as the key conditions for a successful work.

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The travel and tourism sector has become one of the most important sources of the economies of several developed and developing countries for its role in the gross domestic product in addition to its direct effect on the employment , improving the balance of payments position through importing hard currency The present study aims at introducing the concept of tourism , its types and its role in the economical variables as well as the total impact if the increased degree of competition in this sector on the total output of the sample countries. The study divided into two parts the first one focuses on the theoretical frame of this sector while the second part deals with the analysis of the indicators of the development in this sector and its effect on the gross domestic product of the sample countries.