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Russia’s invasion of Ukraine in 2022 triggered a conflict that has transformed international relations through drastic impacts on policymaking, energy politics, and alliances. Such impacts have produced severe multi-dimensional consequences for African countries that have yet to be sufficiently interrogated in the literature. In response to this gap, this paper examined the security implications of the conflict for African countries to offer a comprehensive analysis that considers the intersection of the conflict with contemporary economic, human, social, and political issues confronting Africa. In discourse using a qualitative approach and rooted in a theoretical perspective drawn from the Copenhagen School, the paper underlined the security implications as evident in the areas of food security and governance, buttressing that the proxy conflicts and power struggles associated with this war have exacerbated existing challenges related to food availability and interfered with the consolidation of democracy in Africa. The paper concluded that the war’s multi-dimensional impact potentially compounds political instability vectors. It generates dynamics capable of eroding social cohesion and fomenting social unrest in Africa, meriting its designation as an issue of great concern to African policymakers.

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Purpose: We sought to conduct the largest retrospective study to date of open tibia fractures and describe the incidence of complications and evaluate the potential predictive risk factors for complications. Methods: Patients with open tibia fractures treated with reamed intramedullary nail (IMN) across a 10-year period were evaluated. Patient charts were reviewed for demographics, type of open fracture (T), comorbidities, and postoperative complications. A multivariate model was conducted to determine the risk factors for each type of complication. Results: Of the 486 patients with open tibia fractures, 13 % ( n = 64) had infections, 12 % ( n = 56) had nonunions, and 1 % ( n = 7) had amputations. TIII fractures had much higher rates of each complication than TI and TII fractures. Fracture type was the only significant risk factor for both nonunion and infection. Conclusion: Our study found that the Gustilo grade of open tibia fracture is by far the greatest predictor of nonunion and infection. [ABSTRACT FROM AUTHOR]

Background: Incidental prostate cancers, i.e. cancers found in the specimens of men undergoing surgery for benign prostatic hyperplasia (BPH), have been regarded as non-lethal and harmless, therefore have most times , been left without treatment. However, recent studies have demonstrated otherwise, showing that there is significant mortality associated with the cancer. We determined the occurrence and evaluated the morphologic characteristics of incidental carcinomas of the prostate in a Teaching Hospital in Nigeria. Materials and methods: This was a retrospective review of prostatectomy specimens from patients clinically diagnosed of BPH between 1996 and 2005 at the University of Port Harcourt Teaching Hospital. Results: Age range of patients was 52-87 years, with mean of 67.4 years and peak age group of 60-69 years. Thirty-four (10.3%) of the reviewed 331 cases were positive for incidental carcinomas. All cases were adenocarcinomas. Twelve (35.3%) were well differentiated. Gleason score 5-6 constituted the majority of the cases 18 (52.9%). Eighteen cases (52.9%) were of large acinar morphologic pattern. Conclusion: The incidence of incidental carcinomas of the prostate in our environment is significant, consequently urologists should exercise high index of suspicion while attending to patients clinically diagnosed of BPH. The overall morphologic features portend fair prognosis and contrasts with the established late presenting, and advanced clinical carcinomas with poor prognosis. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore adolescent dietary practices, related norms and acceptable communication platforms in northern Nigeria to inform future nutrition project design., Design: This was a qualitative formative research study. We used purposive sampling and conducted thirty focus group discussions with male and female adolescents aged 10-14 and 15-19 years ( n 180) and six with adult influencers ( n 36). We also administered a 24-h dietary recall with the adolescents using the Diet Quality Questionnaire., Setting: The study was conducted in urban and rural areas in three states in northern Nigeria., Results: Adolescents reported consuming six nutritious food groups the previous day on average. However, there was a wide disparity and only half consumed all five recommended food groups. Adolescents' food choices were influenced by perceptions of the functional and physical benefits of nutritious foods and preferences for satisfying foods. Diverse foods were available in the food environment, but affordability constrained access to nutritious foods. Limited access to income and gender norms constrained adolescent agency over food choice. Girls, particularly those who were pregnant, had less agency related to food than boys. Adolescents thought that peers should be reached through group discussions, radio and phones, among other communication platforms., Conclusions: Adolescents consumed relatively diverse diets. Adolescent food choice was influenced by their embodied experience and knowledge related to nutrition and taste, home food environment and circumscribed agency. Opportunities exist to support healthy diets for adolescents by strengthening adolescents' embodied knowledge, food environments and social support.

Background: Adults hospitalized for cardiovascular events are at high risk for postdischarge mortality. Screening of psychosocial risk is prioritized by the Joint Commission. We tested whether key patient-reported psychosocial and behavioral measures could predict posthospitalization mortality in a cohort of adults hospitalized for a cardiovascular event., Methods: We conducted a prospective cohort study to test the prognostic utility of validated patient-reported measures, including health literacy, social support, health behaviors and disease management, and socioeconomic status. Cox survival analyses of mortality were conducted over a median of 3.5 years., Results: Among 2977 adults hospitalized for either acute coronary syndrome or acute decompensated heart failure, the mean age was 53 years, and 60% were male. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unemployed (hazard ratio [HR]: 1.99, 95% confidence interval [CI]): 1.30-3.06), retired (HR: 2.14, 95% CI: 1.60-2.87), or unable to work due to disability (HR: 2.36, 95% CI: 1.73-3.21), as compared to those who were employed. Patient-reported perceived health competence (PHCS-2) and exercise frequency were also associated with mortality risk after adjusting for all other variables (HR: 0.86, 95% CI: 0.73-1.00 per four-point increase in PHCS-2; HR: 0.86, 95% CI: 0.77-0.96 per 3-day increase in exercise frequency, respectively)., Conclusions: Patient-reported measures of employment status, perceived health competence, and exercise frequency independently predict mortality after a cardiac hospitalization. Incorporating these brief, valid measures into hospital-based screening may help with prognostication and targeting patients for resources during post-discharge transitions of care., (© 2024 The Authors. Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.)

Importance: Sepsis is associated with long-term cognitive impairment and worse psychological and functional outcomes. Potential mechanisms include intracerebral oxidative stress and inflammation, yet little is known about the effects of early antioxidant and anti-inflammatory therapy on cognitive, psychological, and functional outcomes in sepsis survivors., Objective: To describe observed differences in long-term cognitive, psychological, and functional outcomes of vitamin C, thiamine, and hydrocortisone between the intervention and control groups in the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) randomized clinical trial., Design, Setting, and Participants: This prespecified secondary analysis reports the 6-month outcomes of the multicenter, double-blind, placebo-controlled VICTAS randomized clinical trial, which was conducted between August 2018 and July 2019. Adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction who survived to discharge or day 30 were recruited from 43 intensive care units in the US. Participants were randomized 1:1 to either the intervention or control group. Cognitive, psychological, and functional outcomes at 6 months after randomization were assessed via telephone through January 2020. Data analyses were conducted between February 2021 and December 2022., Interventions: The intervention group received intravenous vitamin C (1.5 g), thiamine hydrochloride (100 mg), and hydrocortisone sodium succinate (50 mg) every 6 hours for 96 hours or until death or intensive care unit discharge. The control group received matching placebo., Main Outcomes and Measures: Cognitive performance, risk of posttraumatic stress disorder and depression, and functional status were assessed using a battery of standardized instruments that were administered during a 1-hour telephone call 6 months after randomization., Results: After exclusions, withdrawals, and deaths, the final sample included 213 participants (median [IQR] age, 57 [47-67] years; 112 males [52.6%]) who underwent long-term outcomes assessment and had been randomized to either the intervention group (n = 108) or control group (n = 105). The intervention group had lower immediate memory scores (adjusted OR [aOR], 0.49; 95% CI, 0.26-0.89), higher odds of posttraumatic stress disorder (aOR, 3.51; 95% CI, 1.18-10.40), and lower odds of receiving mental health care (aOR, 0.38; 95% CI, 0.16-0.89). No other statistically significant differences in cognitive, psychological, and functional outcomes were found between the 2 groups., Conclusions and Relevance: In survivors of sepsis, treatment with vitamin C, thiamine, and hydrocortisone did not improve or had worse cognitive, psychological, and functional outcomes at 6 months compared with patients who received placebo. These findings challenge the hypothesis that antioxidant and anti-inflammatory therapy during critical illness mitigates the development of long-term cognitive, psychological, and functional impairment in sepsis survivors., Trial Registration: ClinicalTrials.gov Identifier: NCT03509350.

Objectives: To determine the accuracy of diagnosis of ophthalmic disorders as well as the adequacy of referral of patients with ophthalmic disorders for specialist eye care by the general practitioners (GP)., Materials and Methods: This was a hospital-based descriptive study. Patients selected by systematic random sampling at the General Out-Patient Department (GOPD) of a tertiary hospital were evaluated by the ophthalmologist after they had been independently assessed by the General Practitioners. Diagnoses and referral decisions of the GP were compared with those of the ophthalmologist using Kappa Statistics., Results: A total of 382 patients were studied while 22 GPs participated in the study. Ocular disorders were found by the ophthalmologist in 112 (29.3%) patients while the remaining 270 (70.7%) were normal . Only 36 (32.1%) of those with ocular disorders had a diagnosis of ocular disorders by the General Practitioners. A correct diagnosis was made by the GPs for 18 (16.1%) patients (k=0.102, p =0.001); and the highest diagnostic agreement was obtained for conjunctivitis (k=0.464, P= 0.001). No patient with posterior segment disorder was diagnosed by the GPs. Majority (81%; k = 0.616, p=0.001) of referrals were in agreement with expected referral decision. However, 28 (25.0%) under-referrals and 16 (19.0%) over-referrals were noted., Conclusion: About one-third of all the patients assessed had an ocular disorder, but the general practitioners detected these disorders only one-third of the time; a correct diagnosis of ocular disorders was made in only 16.1%, while no posterior segment disease was diagnosed. Wrong referral decisions were made in up to one-third of patients. Regular update courses for general practitioners on ophthalmic evaluation will help address these observed deficiencies., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Introduction: As clinical trials were rapidly initiated in response to the COVID-19 pandemic, Data and Safety Monitoring Boards (DSMBs) faced unique challenges overseeing trials of therapies never tested in a disease not yet characterized. Traditionally, individual DSMBs do not interact or have the benefit of seeing data from other accruing trials for an aggregated analysis to meaningfully interpret safety signals of similar therapeutics. In response, we developed a compliant DSMB Coordination (DSMBc) framework to allow the DSMB from one study investigating the use of SARS-CoV-2 convalescent plasma to treat COVID-19 to review data from similar ongoing studies for the purpose of safety monitoring., Methods: The DSMBc process included engagement of DSMB chairs and board members, execution of contractual agreements, secure data acquisition, generation of harmonized reports utilizing statistical graphics, and secure report sharing with DSMB members. Detailed process maps, a secure portal for managing DSMB reports, and templates for data sharing and confidentiality agreements were developed., Results: Four trials participated. Data from one trial were successfully harmonized with that of an ongoing trial. Harmonized reports allowing for visualization and drill down into the data were presented to the ongoing trial's DSMB. While DSMB deliberations are confidential, the Chair confirmed successful review of the harmonized report., Conclusion: It is feasible to coordinate DSMB reviews of multiple independent studies of a similar therapeutic in similar patient cohorts. The materials presented mitigate challenges to DSMBc and will help expand these initiatives so DSMBs may make more informed decisions with all available information., Competing Interests: The author Christopher J. Lindsell is both a blinded biostatistician on the PassItOnII trial and member of the DSMBc initiative. The author Thomas G. Stewart is both an unblinded biostatistician on the PassItOnII trial and member of the DSMBc initiative., (© The Author(s) 2022.)

Importance: Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis., Objective: To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis., Design, Setting, and Participants: Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction. Participants were enrolled in the emergency departments or intensive care units at 43 hospitals in the United States between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020., Interventions: Participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone., Main Outcomes and Measures: The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality., Results: Among 501 participants randomized (median age, 62 [interquartile range {IQR}, 50-70] years; 46% female; 30% Black; median Acute Physiology and Chronic Health Evaluation II score, 27 [IQR, 20.8-33.0]; median Sequential Organ Failure Assessment score, 9 [IQR, 7-12]), all completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of -1 day (95% CI, -4 to 2 days; P = .85). Thirty-day mortality was 22% in the intervention group and 24% in the placebo group., Conclusions and Relevance: Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference., Trial Registration: ClinicalTrials.gov Identifier: NCT03509350.

Background: Disease-modifying therapy (DMT) delays disease progression and improves quality of life for patients with multiple sclerosis (MS), but adherence to DMT is often suboptimal. Vanderbilt Specialty Pharmacy (VSP) embeds pharmacists within an outpatient MS clinic to provide medication management and address barriers to adherence., Objective: We evaluated rates and predictors of adherence to DMT among patients with MS at an integrated specialty pharmacy., Methods: We included patients with MS who filled ≥3 DMT prescriptions from VSP during the study period. Adherence was defined as medication possession ratio (MPR) or proportion of days covered (PDC) ≥0.8. Reasons for nonadherence were collected from pharmacy claims and electronic medical records., Results: The study included 653 patients. Average MPR and PDC were 0.93 and 0.94, respectively. Eighty-eight percent of patients achieved MPR ≥0.8; 89% achieved PDC ≥0.8. Using financial assistance and having $0 out-of-pocket cost were associated with higher odds of achieving MPR and PDC ≥0.8 ( P < .05). Of the 12% of patients who were nonadherent, most were unreachable for refills., Conclusions: Ensuring financial assistance and low out-of-pocket costs are associated with high adherence to DMT within an integrated specialty clinic, but more work is needed to address adherence in unreachable patients.