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Objective: Despite the health benefits, many people do not undertake regular exercise. This study investigated the effects of moderate-intensity exercise on cardiorespiratory fitness (lung age, blood pressure and maximal aerobic power, VO[subscript 2]max), serum lipids concentration and body mass index (BMI) in sedentary overweight/obese adults consuming a calorie-restricted low-fat diet. Design: Randomized diet and exercise intervention. Setting: Lincolnshire, UK. Methods: Sixty overweight/obese (BMI greater than or equal to 25kgm[superscript -2]) adults were randomized to either a calorie restricted low-fat diet (20 per cent of total energy as fat) or the same diet with the addition of moderate-intensity physical exercise (30 minutes, twice a week) for eight weeks; 20 completed the study. Participants' serum lipids concentrations, BMI, blood pressure, resting pulse rate, VO[subscript 2]max and lung age were measured before the start of the intervention and during the fourth and eighth weeks. Results: Reductions in blood pressure (10 per cent versus 1 per cent), pulse rate (13 per cent versus 8 per cent) and weight (5 per cent versus 2 per cent) were greatest for the diet with exercise group. Exercise resulted in a significant (p less than or equal to 0.05) increase in average VO[subscript 2]max (by 17 per cent) and reduction in average lung age by about 19 years. Further, reduction in participants' lung age ranged from 1 to 37 years. However, there was no significant difference in BMI, blood pressure and serum lipids concentration between groups. Conclusion: Although exercise on most days of the week would result in maximum health benefits, 30 minutes of moderate-intensity exercise twice a week could significantly improve cardiorespiratory fitness (blood pressure and lung age) and the risk of cardiovascular diseases in previously sedentary overweight/obese adults. (Contains 2 figures and 2 tables.)

The presence of amidases cleaving the tripeptide VAL.LEU.ARG.PNA, and liberating from human plasma kininogen substance(s) able to contract uterine smooth muscle and to lower blood pressure (uterus contracting and hypotensive activity), has been demonstrated in vascular and muscle tissues from normally perfused and ischaemic areas of dog hearts. Studies were carried out on blood free preparations of coronary arteries and veins and normally perfused and ischaemic ventricle. All the tissues were found to contain both acid optimum (pH 6) and alkaline optimum (pH> 9) enzymes forming uterus contracting substance (UCS, bioassayed on isolated uterus of rats in oestrus), the highest levels of both activities being found in arterial tissues and the least in ventricle. Enzyme levels in ischaemic or normally perfused ventricle did not differ significantly. Gel filtration (Sephacryl, S-300) of coronary artery extracts gave one peak each of acid optimum enzyme with a molecular weight of 38 300±800 daltons and alkaline optimum enzyme with a molecular weight of 92 100±4000 daltons. Both acid and alkaline enzyme fractions cleaved the tripeptide substrate with pH optima identical to those for UCS formation. The acid optimum activity, both of UCS formation and tripeptide cleavage, was inhibited by pepstatin but not by aprotinin or soybean trypsin inhibitor (SBTI). The alkaline optimum activity was inhibited by aprotinin and SBTI but not pepstatin. Both acid and alkaline optimum enzymes released a hypotensive agent from a plasma protein substrate. The molecular weight and response to inhibitors of the acid optimum enzyme were similar to a cathepsin, and those of the alkaline optimum enzyme were similar to plasma kallikrein. [ABSTRACT FROM PUBLISHER]

Background: Social support is associated with improved clinical outcomes but is understudied among US immigrants. We examined two types of social support, perceived health provider support and community support, and characterized perceptions of social support among US immigrants compared with nonimmigrants., Methods: We conducted cross-sectional data analysis on self-reported data from Health Information National Trends Survey 5, Cycle 2. Population-level estimates were obtained using jack-knife replicate weights., Results: Immigrant status was not associated with perceived health care provider support or community support. However, compared with nonimmigrants, US immigrants were more likely to report rarely (adjusted odds ratio [aOR]=3.07) or never (aOR=3.18) having access to emotional support., Conclusions: Further research that incorporates nuanced factors (eg, time since arrival) that may influence social support in diverse US immigrant groups is needed to determine the impact of social support on health outcomes in an underserved and often overlooked population., Competing Interests: Conflict of Interest: No conflict of interest reported by authors.

Lassa fever (LF) is prevalent in many West African countries, including Nigeria. Efforts to combat LF have primarily focused on rural areas where interactions between rodents and humans are common. However, recent studies indicate a shift in its occurrence from rural to urban areas. We analysed secondary data of reported LF outbreaks from 2017 to 2021 in Ondo State, Nigeria to identify the distribution pattern, ecological variations, and other determinants of disease spread from the ward level using nearest neighbour statistics and regression analysis. Data utilised include LF incidence, ecological variables involving population, nighttime light intensity, vegetation, temperature, market presence, road length, and building area coverage. ArcGIS Pro 3.0 software was employed for spatial analysis. Results revealed spatio-temporal clustering of LF incidents between 2017 and 2021, with an increasing trend followed by a decline in 2021. All wards in Owo Local Government Area were identified as LF hotspots. The ecological variables exhibited significant correlations with the number of LF cases in the wards, except for maximum temperature. Notably, these variables varied significantly between wards with confirmed LF and those without. Therefore, it is important to prioritise strategies for mitigating LF outbreaks in urban areas of Nigeria and other LF-endemic countries., (© 2023. The Author(s).)

Background: Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations., Methods: We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively., Results: Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively., Conclusion: Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined., (© 2023. The Author(s).)

Background: The World Health Organization recently declared vaccine hesitancy or refusal as a threat to global health. COVID-19 vaccines have been proven efficacious and are central to combatting the pandemic. However, many-including skilled health care workers (HCWs)-have been hesitant in taking the vaccines. Conspiracy theories spread on social media may play a central role in fueling vaccine hesitancy., Objective: The objective of this study was to investigate HCWs' belief in COVID-19 vaccine conspiracy theories (ie, that the vaccines can alter one's DNA or genetic information and that the vaccines contain microchips) and trust in government information on COVID-19 vaccines., Methods: Health care workers in Ondo State, Nigeria, representing different health care professions were asked to participate anonymously in an online survey. The participants were asked about their beliefs in 2 viral conspiracy theories and their trust in government information on COVID-19 vaccines. We used multivariable logistic regressions to investigate the relationships between trust in government information on COVID-19 vaccines and (1) belief in DNA alteration, (2) belief in microchip implantation through the vaccine, and (3) willingness to accept the vaccine., Results: A total of 557 HCWs (n=156, 28% men and n=395, 70.9% women) were included in the study. A total of 26.4% (n=147) of the sampled HCWs believed COVID-19 vaccines contained digital microchips, while 30% (n=167) believed the vaccines could alter one's DNA or genetic information. The beliefs varied according to professional group, with 45.8% (55/120) and 50% (5/10) of nurses and pharmacists, respectively, believing in the DNA alteration theory and 33.3% (40/120) and 37.5% (6/16) of the nurses and laboratory scientists, respectively, believing in the microchip theory. Social media was an important source of COVID-19 information for 45.4% (253/557) of HCWs. A total of 76.2% (419/550) of the participants expressed a willingness to take the vaccine. The odds of HCWs believing that COVID-19 vaccines contained digital microchips increased significantly with decreasing level of trust in government information on COVID-19 vaccines (odds ratio [OR] 4.6, 95% CI 2.6-8.0). We made a similar finding in those who believed COVID-19 vaccines could alter DNA and genetic information (OR 5.2, 95% CI 3.1-8.8)., Conclusions: Misinformation regarding COVID-19 vaccines reaches and influences HCWs. A high proportion of the sampled HCWs believed that COVID-19 vaccines contained microchips or that the vaccines could alter recipients' DNA and genetic information. This might have negative consequences in terms of the HCWs' own COVID-19 vaccination and their influence on other people. Lack of trust in government and its institutions might explain the belief in both conspiracy theories and vaccine hesitancy. There is a need for health care stakeholders in Nigeria and around the world to actively counteract misinformation, especially on social media, and give HCWs necessary scientifically sound information., (©Sunday Oluwafemi Oyeyemi, Stephen Fagbemi, Ismaila Iyanda Busari, Rolf Wynn. Originally published in JMIR Formative Research (https://formative.jmir.org), 02.05.2023.)

Background: Large outbreaks of Lassa fever (LF) occur annually in Nigeria. The case fatality rate among hospitalised cases is ~ 20%. The antiviral drug ribavirin along with supportive care and rehydration are the recommended treatments but must be administered early (within 6 days of symptom onset) for optimal results. We aimed to identify factors associated with late presentation of LF cases to a healthcare facility to inform interventions., Methods: We undertook a retrospective cohort study of all laboratory confirmed LF cases reported in Nigeria from December 2018 to April 2019. We performed descriptive epidemiology and a univariate Cox proportional-hazards regression analysis to investigate the effect of clinical (symptom severity), epidemiological (age, sex, education, occupation, residential State) and exposure (travel, attendance at funeral, exposure to rodents or confirmed case) factors on time to presentation., Results: Of 389 cases, median presentation time was 6 days (IQR 4-10 days), with 53% attending within 6 days. There were no differences in presentation times by sex but differences were noted by age-group; 60+ year-olds had the longest delays while 13-17 year-olds had the shortest. By sex and age, there were differences seen among the younger ages, with 0-4-year-old females presenting earlier than males (4 days and 73% vs. 10 days and 30%). For 5-12 and 13-17 year-olds, males presented sooner than females (males: 5 days, 65% and 3 days, 85% vs. females: 6 days, 50% and 5 days, 61%, respectively). Presentation times differed across occupations 4.5-9 days and 20-60%, transporters (people who drive informal public transport vehicles) had the longest delays. Other data were limited (41-95% missing). However, the Cox regression showed no factors were statistically associated with longer presentation time., Conclusions: Whilst we observed important differences in presentation delays across factors, our sample size was insufficient to show any statistically significant differences that might exist. However, almost half of cases presented after 6 days of onset, highlighting the need for more accurate and complete surveillance data to determine if there is a systemic or specific cause for delays, so to inform, monitor and evaluate public health strategies and improve outcomes.

Multiphase flow in porous media has been thoroughly studied over the years and its importance is encountered in several areas related to geo-materials. One of the most important parameters that control multiphase flow in any complex geometry is wettability, which is an affinity of a given fluid toward a surface. In this paper, we have quantified the effects of wettability on deformation in porous media, along with other parameters that are involved in this phenomenon. To this end, we conducted numerical simulations on a porous medium by coupling the exchanged forces between the fluid and solid. To include the effect of wettability in the medium, we used the Fictitious Domain methodology and coupled it with volume of fluid through which one can model more than one fluid in the system. To observe the effect of wettability on dynamic processes in the designated porous medium, such as deformation, particle-particle contact stresses, particle velocity, and injection pressure, a series of systematic computations were conducted where wettability is varied through five different contact angles. We found that wettability not only controls the fluid propagation patterns but also affects drag forces exerted on the particles during injection such that larger deformations are induced for particles with lower wettability. Our results are also verified against experimental tests., (Copyright © 2020 Author(s).)

Understanding of multiphase flow in porous media is important for a wide range of applications such as soil science, environmental remediation, energy resources, and CO_{2} sequestration. This phenomenon depends on the complex interplay between the fluid and solid forces such as gravitational, capillary, and viscous forces, as well as wettability of the solid phase. Such interactions along with the geometry of the medium give rise to a variety of complex flow regimes. Although much research has been done in the area of wettability, its mechanical effect is not well understood, and it continues to challenge our understanding of the phenomena on macroscopic and microscopic scales. In this paper, therefore, the effect of wettability on the deformation of porous media and fluid-fluid patterns is studied through a series of three-dimensional (3D) simulations. To this end, the discrete element method (DEM) and volume of fluid (VOF) are coupled to accurately model free-surface flow interaction in a cylindrical pack of spheres. The fluid-particle interactions are modeled by exchanging information between DEM and VOF, while the effect of wettability is considered to study how it controls fluid displacement. The results indicate that the drag force and deformation in the pack vary with the change in wettability and capillary number. To demonstrate the effect of both wettability and capillary number, a series of numerical experiments were conducted with two capillary numbers and three wettability conditions. Our results show that the drag force was greatest for near extreme wettability conditions, which resulted in a larger deformation.

Community practice experience allows a nonselective care of patient using information derived from a more controlled clinical trial environment. We present our community experience with multiple myeloma patients with advanced age, long disease duration since diagnosis, advanced stage, multiple prior therapies including stem cell transplantation, co-morbidities, and other poor prognostic features, such as low albumin, high B-2 microglobulin, renal failure, and the presence of poor risk chromosomal abnormalities. Our response rates are comparable to those from clinical trials. Bortezomib is well tolerated in this population of multiple myeloma patients with the exception of infection adverse events that are generally mild grade 1-2.

We evaluated CT findings in 75 Nigerians who suffer from epilepsy aged 12 years and over to determine factors associated with positive yield for judicious utilisation of CT. There were 48 males and 27 females with a mean age of 36 +/- 15 years. CT was normal in 41 subjects (54.7%). The commonest CT abnormality was cortical atrophy encountered in 16 subjects. The other abnormalities were occupying lesions (13) comprising 11 neoplasms and 2 subdural haematoma, vascular lesions (4) and poroencephaly (1). The presence of CT abnormality was statistically significantly associated with neurologic deficit, partial seizure type and EEG abnormalities (P < 0.05). The decision on when to request CT scan in epileptics could therefore be influenced by our findings.

The intravenous administration of either aspirin, (in doses of 1 and 3 mg/kg) sodium meclofenamate (1 and 3 mg/kg) or indomethacin (1 and 3 mg/kg) markedly reduced ventricular arrhythmias (VT and VF) induced by coronary artery ligation in anaesthetised rats. Their effect were very pronounced on ventricular ectopic activity occurring between the sixteenth and thirtieth min. These effects suggest the desirability of combining the non steroidal anti-inflammatory drugs with beta-adrenergic blockers in the treatment of ventricular arrhythmias following acute myocardial infarction.

1 The relaxant effect of noradrenaline on strips of guinea-pig isolated terminal ileum was blocked by pretreatment with prazosin, phentolamine, yohimbine and phenoxybenzamine. 2 The presence of a very high concentration of noradrenaline (50 micrometers) during exposure to the blocking agent protected against the blocking effect of the drugs. 3 Yohimbine, prazosin and phentolamine partially protected against irreversible blockade by phenoxybenzamine. 4 Spontaneous release of acetylcholine in the unstimulated ileum was blocked by noradrenaline (0.05-5.9 micrometers) this effect of noradrenaline was antagonized by phentolamine (0.13-26 micrometers) and yohimbine (0.051-0.51 micrometers) but not prazosin (0.53-5.3 micrometers) or phenoxybenzamine (4.2-42 nm). All four antagonists reversed the noradrenaline-induced relaxation of the ileum. 5 Acetylcholine output in the transmurally stimulated ileum was inhibited by noradrenaline. This effect of noradrenaline was antagonized by phentolamine and yohimbine but not by prazosin or phenoxybenzamine. The first two antagonists blocked the noradrenaline-induced inhibition of evoked twitches of the ileum while the last two had no effect. 6 The results show (a) that prazosin has no effect on presynaptic alpha-adrenoceptor located on cholinergic nerve endings in the guinea-pig ileum and (b) that prazosin, phentolamine and phenoxybenzamine act on the same subgroup of postsynaptic alpha-adrenoceptors on the smooth muscle of the guniea-pig ileum.

1 The alpha-adrenoceptor blocking activity of prazosin was compared with that of phentolamine, yohimbine and phenoxybenzamine in the guinea-pig isolated ileum. 2 Phentolamine (2.56 X 10(-8) to 2.56 X 10(-6) M) and yohimbine (5.12 X 10(-8) to 5.12 X 10(-6) M) antagonized the sympathetic inhibition of twitches induced by transmural stimulation, whereas prazosin (5.28 X 10(-8) to 5.28 X 10(-6) M) and phenoxybenzamine (4.2 X 10(-9) to 4.2 X 10(-7) M) had no effect. 3 Phentolamine, yohimbine, prazosin and phenoxybenzamine antagonized the relaxant response of the ileum to periarterial nerve stimulation and to exogenous noradrenaline in the absence of transmural stimulation. 4 The pA2 value for phentolamine against noradrenaline in the transmurally-stimulated gut (presynaptic alpha-adrenoceptor site; 8.17 +/- 0.04) was significantly different from that in the non-stimulated gut (postsynaptic alpha-adrenoceptor site; 6.88 +/- 0.12). 5 Phentolamine and prazosin probably block noradrenaline responses at the same alpha-adrenoceptor site on the postsynaptic membrane.