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Background: In Africa, cancer is an emerging public health concern. In Sub-Saharan Africa, data on cancer epidemiology and survival which are necessary for the planning of treatment and control of cancers are scarce. Methods: A retrospective study of all patients who were admitted to the surgical wards in a Nigerian tertiary facility between January 2012 and December 2016 was done. The retrieved data included demographic features, presenting symptoms, mode of presentation, duration of illness, diagnosis, stage of disease, treatment modalities, treatment intention, compliance with treatment, survival, and current status. Result: The 279 patients studied comprised 81 (29.0%) males and 198 (71.0%) females. Cancer of the female breast was the leading malignancy occurring in 59% (165/279) patients; this was followed by colon cancer in19% (54/279) and prostate cancer in 10% (29/279). The commonest cancer among the females was breast cancer while prostate cancer was the commonest among the males. The stage of the disease was classified as early in 14.7% (41/279), locally advanced in 61.6% (172/279) and metastatic in 23.7% (66/279). Treatment goal was palliative for 57% (159/279) of the patients, curative in 26%while 13.6% (38/279) of the patients received no anti-cancer treatment. Ninety-six patients (34.5%) refused treatment or defaulted from treatment after the commencement of therapy. Although 53 (19%) patients died within the first month of admission, the overall mean duration of survival was 12.71 ± 13.0 months (range of 1- 84 months). Conclusion: Late presentation of patients, high treatment default rate, inappropriate management plan and overall poor survival were identified as daunting issues in cancer management in a resource-limited setting.

Background: Newer methods have evolved to address the major drawback of the traditional methods of hernia repair. These emphasize the use of prosthetic materials to strengthen the posterior wall of the inguinal canal without tension. Although Lichtenstein hernioplasty, like other newer methods, is associated with low recurrence rates, it is not commonly used in our clinical setting. Objective: To review the outcome of Lichtenstein hernioplasty using polypropylene mesh in a resource-poor setting. Methods: The hospital records of patients who had Lichtenstein hernioplasty between the year 2004 and 2013 in a six-bed private surgical clinic and who were followed up over a two- to ten-year period, were studied. Demographic data, clinical features, operative findings and outcome measures like post-operative complications and recurrence rates, were recorded. Results: There were 62 patients (with 69 hernias) of which 2 were females with the age range of 12-84years. 50 hernias (72.5%) were of the inguinoscrotal type, 39 patients (63.0%) had right inguinal hernias, 5 (7.2%) hernias were obstructed and 8 (11.2%) hernias were recurrent. Six (9.7%) had emergency surgery, 46 (74.2%) had surgery under local infiltrations and 15 (24.2%) had spinal anaesthesia. Scrotal oedema (4.3%), haematoma (1.4%), and hydrocoele (1.4%) were the early complications recorded. One recurrence of hernia occurred in a patient who had repair of twice recurrent hernia. The mean duration of follow-up in years was 5 (S.D 2.5) years. Conclusion: Lichtenstein repair of inguinal hernia was a safe and effective procedure in the private clinical setting.

Background: Some childhood diseases present with abdominal masses alone or with other constitutional symptoms. The knowledge of the common causes of abdominal masses in children can assist in developing a protocol of management by clinicians. Objective: To describe the aetiology and presentation of abdominal masses in children. Methods: The hospital records of all cases of intra-abdominal masses in children managed between May 1998 and April 2008 were retrieved for analysis. Socio-demographic and clinical data were obtained and analysed using simple descriptive statistics. Results: A total of 93 children were included while those without clinical, radiological and intra-operative evidence of intra-abdominal masses were excluded from the study. There were 49 males (52.7%) and 44 (47.3%) females with male-to-female ratio of 1.1:1. The children were aged 1 day to 14 years; 15 (16.1%) were aged 6-9 years, >9-12 years and >12-14 years. The most common cause of abdominal masses was appendiceal mass/abscess in 29%, followed by hydronephrosis in 22.6% and nephroblastoma in 16.11%. The most common symptoms included abdominal pain (86.0%), fever (46.2%), vomiting (40.9%) and abdominal distension (32.2%). The mortality rate was 13%. Conclusion: Non-malignant conditions were mostly responsible for abdominal masses in children while abdominal pain, fever and vomiting were the leading presentations of abdominal masses in children.

Background: Restoration of intestinal continuity after Hartmann’s colostomy can be very difficult especially in patients with short rectal stumps that are retracted and buried deep in the pelvis. Objective: To demonstrate a simple method of overcoming the difficulty in the reversal of Hartmann’s colostomy. Method: A retrospective descriptive study of cases of Hartmann’s colostomy reversal was done. Results: The technique was used in the reversal of 9 Hartmann’s colostomies carried out over a period of 16 years between 1995 and 2010. The patients comprised five males and four females. The diagnoses in the males were four cases of sigmoid volvulus, and one gunshot injury. The diagnoses in the four females included sigmoid volvulus, carcinoma of the colon, stricture from endometriosis and gangrenous sigmoid colon from criminal abortion. The mean time for restoration of intestinal continuity after the primary procedure was 7.8 months. Two patients had postoperative wound infection. There was no mortality. Conclusion: The simple technique was found to be helpful especially in situations where other instruments that facilitate the restorative process are not available

With the continuous clamor for a reduction in embodied carbon in cement, rapid solution to climate change, and reduction to resource depletion, studies into substitute binders become crucial. These cementitious binders can potentially lessen our reliance on cement as the only concrete binder while also improving concrete functional properties. Finer particles used in cement microstructure densify the pore structure of concrete and enhance its performance properties. The compressive strength of concrete made from a mixture of ground granulated blast furnace slag (GGBFS), fly ash (FA), and ordinary Portland cement was estimated using kernel regression techniques in this work. The kernel-based method offered was support vector regression (SVR), while robust linear regression (RLR), and multi-linear regression (MLR) were used as regression methods, subsequently, nonlinear average approaches were used to improve the accuracy of the prediction. Eight variables (cement, FA, GGBFS, water, superplasticizer dose [SP], coarse aggregate [CA], fine aggregate [F ag ], age) were employed as input features in 3323 data samples, and their relative value was assessed using linear correlation analysis. Following analysis, three combinations were employed to train the kernel-based models: I (inputs: cement, water, and age|output: CS), II (inputs: cement, water, FA, SP, and age|output: CS), and III (inputs: cement, water, FA, SP, CA, GGBFS, and F ag |output: CS). The third combination gave the best testing performance with all the proposed models where their R 2 and MSE results after model evaluation for SVR, RLR, and MLR, are [0.984, 0.8776 and 0.8804] and [0.0019, 0.0131 and 0.0128] respectively. The study concludes that SVR with the combination III (SVR-M3) offered the best performance through effectiveness and efficiency in accurately predicting the compressive strength of the blended concrete. The prediction models should be utilized with the input variable ranges used in this work., Competing Interests: Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024. The Author(s).)

This article provides insight into an aspect of the National Health Service (NHS) of the United Kingdom (UK) through the perspective of an overseas clinical observer. The NHS is a government-funded medical and health care service in the UK and has developed over the years providing a high standard of medical care and professionalism. The Clinical Observership Programme has been designed primarily for International Medical Graduates to experience how the NHS functions and the kind of services it offers. This article explores the overseas observer's experience in a surgical unit of the NHS including the organisational structure, delivery of care and challenges of the system. This article also highlights the observer's perspective of surgical care in the NHS compared to surgical care in low-resource income countries. The Clinical Observership is useful in learning about UK medical practice and gaining experience in a different cultural and professional environment. This is a reflective first-hand account based on personal experience.

Due to the significant energy and economic losses brought on by the global oil spill, there has been an increased interest in oil-water separation. This study presents strong non-linear machine learning models (support vector regression (SVR) and Gaussian process regression (GPR)) with the Response surface method (RSM) to predict the oil flux and oil-water separation efficiency of wastewater using ceramic membrane technology. For the model development and prediction of oil flux (OF) and oil-water separation efficiency (OSE), oil concentration (mg/L), feed flow rate (mL/min), and pH were considered as input variables. The input variables are combined in three combinations to study the most contributing input features to the models' performance. Mean square error (MSE) and Nash-Sutcliffe coefficient efficiency (NSE) were used to assess the prediction performances of the developed models with the different number of input combinations considered in the study. For the two target variables (OF and OSE), GPR and SVR models were used to separately predict them. For OF, the SVR-2 [Combo-2] model (MSE = 0.9255 and NSE = 2.7976) performed better with higher prediction accuracy compared to GPR-2 [Combo-2] model (MSE = 0.763 and NSE = 6.437). In addition, for OSE, the GPR-3 [Combo-3] model (MSE = 0.995 and NSE = 0.5544) performed slightly better than SVR-3 [Combo-3] model (MSE = 0.992 and NSE = 0.8066). The results showed that the SVR model with the combo-2 and GPR-3 models for OF and OSE variables are the proposed models with the best performance and accuracy. This machine learning study will aid in better evaluating the function of materials such as ceramic in membrane performance features such as oil flux and rejection prediction, separation efficiency, water recovery, membrane fouling, and so on. As for academics and manufacturers, this machine learning (ML) strategy will boost performance and allow a better understanding of system governance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Alkali-activated concrete (AAC) or binders (AABs) have emerged as a substitute to conventional ordinary Portland cement (OPC)-based concrete owing to their techno-ecological merits. Saudi Arabia has vast resources of natural pozzolan whose impact on some fresh and hardened properties was encouraging; however, the long-term shrinkage behavior of AABs and life cycle assessment (LCA) of the developed product is yet to be explored. Therefore, this study evaluates shrinkage characteristics and LCA of Saudi natural pozzolan (NP)-based AAC. The synergistic impact of admixing nano-silica (NS) up to 7.5% dosage was also observed on the properties of engineered AABs in comparison with OPC-based concrete. The shrinkage properties were correlated with the microstructure and pore structure. The study revealed that the shrinkage properties of both NP-based AABs and OPC-based concrete are comparable. However, adding NS increased the drying shrinkage strain because of the finer pore structure than AABs without NS, which was confirmed through nuclear magnetic resonance (NMR). The maximum average drying shrinkage strain of 510 με was recorded in the OPC concrete, whereas in the engineered AAC with 0, 1, 2.5, 5, and 7.5% NS, it was 486, 537, 568, 601, and 651 με, respectively. It is postulated that the NP can be beneficially valorized in the production of green AABs without compromising the shrinkage characteristics, while the NS is favorable for enhancing the strength and refinement of the pore matrix. Besides, the LCA indicated the feasibility of recycling the high volume of natural waste by AAB technology, which significantly lowers the carbon footprints and minimizes the environmental implications in infrastructural applications., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The corrosion of steel reinforcement necessitates regular maintenance and repair of a variety of reinforced concrete structures. Retrofitting of beams, joints, columns, and slabs frequently involves the use of fiber-reinforced polymer (FRP) laminates. In order to develop simple prediction models for calculating the interfacial bond strength (IBS) of FRP laminates on a concrete prism containing grooves, this research evaluated the nonlinear capabilities of three ensemble methods—namely, random forest (RF) regression, extreme gradient boosting (XGBoost), and Light Gradient Boosting Machine (LIGHT GBM) models—based on machine learning (ML). In the present study, the IBS was the desired variable, while the model comprised five input parameters: elastic modulus x thickness of FRP (EfTf), width of FRP plate (bf), concrete compressive strength (fc′), width of groove (bg), and depth of groove (hg). The optimal parameters for each ensemble model were selected based on trial-and-error methods. The aforementioned models were trained on 70% of the entire dataset, while the remaining data (i.e., 30%) were used for the validation of the developed models. The evaluation was conducted on the basis of reliable accuracy indices. The minimum value of correlation of determination (R2 = 0.82) was observed for the testing data of the RF regression model. In contrast, the highest (R2 = 0.942) was obtained for LIGHT GBM for the training data. Overall, the three models showed robust performance in terms of correlation and error evaluation; however, the trend of accuracy was obtained as follows: LIGHT GBM > XGBoost > RF regression. Owing to the superior performance of LIGHT GBM, it may be considered a reliable ML prediction technique for computing the bond strength of FRP laminates and concrete prisms. The performance of the models was further supplemented by comparing the slopes of regression lines between the observed and predicted values, along with error analysis (i.e., mean absolute error (MAE), and root-mean-square error (RMSE)), predicted-to-experimental ratio, and Taylor diagrams. Moreover, the SHAPASH analysis revealed that the elastic modulus x thickness of FRP and width of FRP plate are the factors most responsible for IBS in FRP.

The depletion of natural resources of river sand and its availability issues as a construction material compelled the researchers to use manufactured sand. This study investigates the compressive strength of concrete made of manufactured sand as a partial replacement of normal sand. The prediction model, i.e., gene expression programming (GEP), was used to estimate the compressive strength of manufactured sand concrete (MSC). A database comprising 275 experimental results based on 11 input variables and 1 target variable was used to train and validate the developed models. For this purpose, the compressive strength of cement, tensile strength of cement, curing age, Dmax of crushed stone, stone powder content, fineness modulus of the sand, water-to-binder ratio, water-to-cement ratio, water content, sand ratio, and slump were taken as input variables. The investigation of a varying number of genetic characteristics, such as chromosomal number, head size, and gene number, resulted in the creation of 11 alternative models (M1-M11). The M5 model outperformed other created models for the training and testing stages, with values of (4.538, 3.216, 0.919) and (4.953, 3.348, 0.906), respectively, according to the results of the accuracy evaluation parameters root mean square error (RMSE), mean absolute error (MAE), and coefficient of determination (R2). The R2 and error indices values revealed that the experimental and projected findings are in extremely close agreement. The best model has 200 chromosomes, 8 head sizes, and 3 genes. The mathematical expression achieved from the GEP model revealed that six parameters, namely the compressive and tensile strength of cement, curing period, water−binder ratio, water−cement ratio, and stone powder content contributed effectively among the 11 input variables. The sensitivity analysis showed that water−cement ratio (46.22%), curing period (25.43%), and stone powder content (13.55%) were revealed as the most influential variables, in descending order. The sensitivity of the remaining variables was recorded as w/b (11.37%) > fce (2.35%) > fct (1.35%).

Stabilized aggregate bases are vital for the long-term service life of pavements. Their stiffness is comparatively higher; therefore, the inclusion of stabilized materials in the construction of bases prevents the cracking of the asphalt layer. The effect of wet−dry cycles (WDCs) on the resilient modulus (Mr) of subgrade materials stabilized with CaO and cementitious materials, modelled using artificial neural network (ANN) and gene expression programming (GEP) has been studied here. For this purpose, a number of wet−dry cycles (WDC), calcium oxide to SAF (silica, alumina, and ferric oxide compounds in the cementitious materials) ratio (CSAFRs), ratio of maximum dry density to the optimum moisture content (DMR), confining pressure (σ3), and deviator stress (σ4) were considered input variables, and Mr was treated as the target variable. Different ANN and GEP prediction models were developed, validated, and tested using 30% of the experimental data. Additionally, they were evaluated using statistical indices, such as the slope of the regression line between experimental and predicted results and the relative error analysis. The slope of the regression line for the ANN and GEP models was observed as (0.96, 0.99, and 0.94) and (0.72, 0.72, and 0.76) for the training, validation, and test data, respectively. The parametric analysis of the ANN and GEP models showed that Mr increased with the DMR, σ3, and σ4. An increase in the number of WDCs reduced the Mr value. The sensitivity analysis showed the sequences of importance as: DMR > CSAFR > WDC > σ4 > σ3, (ANN model) and DMR > WDC > CSAFR > σ4 > σ3 (GEP model). Both the ANN and GEP models reflected close agreement between experimental and predicted results; however, the ANN model depicted superior accuracy in predicting the Mr value.

Coal mining waste in the form of coal gangue (CG) was established recently as a potential fill material in earthworks. To ascertain this potential, this study forecasts the strength and California Bearing Ratio (CBR) characteristics of chemically stabilized CG by deploying two widely used artificial intelligence approaches, i.e., artificial neural network (ANN) and random forest (RF) regression. In this research work, varied dosage levels of lime (2, 4, and 6%) and gypsum (0.5, 1, and 1.5%) were employed for determining the unconfined compression strength (UCS) and CBR of stabilized CG mixes. An experimental study comprising 384 datasets was conducted and the resulting database was used to develop the ANN and RF regression models. Lime content, gypsum dosage, and 28 d curing period were considered as three input attributes in obtaining three outputs (i.e., UCS, unsoaked CBR, and soaked CBR). While modelling with the ANN technique, different algorithms, hidden layers, and the number of neurons were studied while selecting the optimum model. In the case of RF regression modelling, optimal grid comprising maximal depth of tree, number of trees, confidence, random splits, enabled parallel execution, and guess subset ratio were investigated, alongside the variable number of folds, to obtain the best model. The optimum models obtained using the ANN approach manifested relatively better performance in terms of correlation coefficient values, equaling 0.993, 0.995, and 0.997 for UCS, unsoaked CBR and soaked CBR, respectively. Additionally, the MAE values were observed as 45.98 kPa, 1.41%, and 1.18% for UCS, unsoaked CBR, and soaked CBR, respectively. The models were also validated using 2-stage validation processes. In the first stage of validation of the model (using unseen 30% of the data), it was revealed that reliable performance of the models was attained, whereas in the second stage (parametric analysis), results were achieved which are corroborated with those in existing literature.

An accurate calculation of the flexural capacity of flexural members is vital for the safe and economical design of FRP reinforced structures. The existing empirical models are not accurately calculating the flexural capacity of beams and columns. This study investigated the estimation of the flexural capacity of beams using non-linear capabilities of two Artificial Intelligence (AI) models, namely Artificial neural network (ANN) and Random Forest (RF) Regression. The models were trained using optimized hyperparameters obtained from the trial-and-error method. The coefficient of correlation (R), Mean Absolute Error, and Root Mean Square Error (RMSE) were observed as 0.99, 5.67 kN-m, and 7.37 kN-m, for ANN, while 0.97, 7.63 kN-m, and 8.02 kN-m for RF regression model, respectively. Both models showed close agreement between experimental and predicted results; however, the ANN model showed superior accuracy and flexural strength performance. The parametric and sensitivity analysis of the ANN models showed that an increase in bottom reinforcement, width and depth of the beam, and increase in compressive strength increased the bending moment capacity of the beam, which shows the predictions by the model are corroborated with the literature. The sensitivity analysis showed that variation in bottom flexural reinforcement is the most influential parameter in yielding flexural capacity, followed by the overall depth and width of the beam. The change in elastic modulus and ultimate strength of FRP manifested the least importance in contributing flexural capacity.

Water and wastewater treatment applications stand to benefit immensely from the design and development of new materials based on silica nanoparticles and their derivatives. Nanosilica possesses unique properties, including low toxicity, chemical inertness, and excellent biocompatibility, and can be developed from a variety of sustainable precursor materials. Herein, we provide an account of the recent advances in the synthesis and utilization of nanosilica for wastewater treatment. This review covers key physicochemical aspects of several nanosilica materials and a variety of nanotechnology-enabled wastewater treatment techniques such as adsorption, separation membranes, and antimicrobial applications. It also discusses the prospective design and tuning options for nanosilica production, such as size control, morphological tuning, and surface functionalization. Informative discussions on nanosilica production from agricultural wastes have been offered, with a focus on the synthesis methodologies and pretreatment requirements for biomass precursors. The characterization of the different physicochemical features of nanosilica materials using critical surface analysis methods is discussed. Bio-hybrid nanosilica materials have also been highlighted to emphasize the critical relevance of environmental sustainability in wastewater treatment. To guarantee the thoroughness of the review, insights into nanosilica regeneration and reuse are provided. Overall, it is envisaged that this work's insights and views will inspire unique and efficient nanosilica material design and development with robust properties for water and wastewater treatment applications., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The usual cause of penetrating thoracoabdominal injuries with evisceration are stab wounds with knives and other sharp weapons used during fights and conflicts. Evisceration of the abdominal viscera as a result of trauma, with its attendant morbidity and mortality, requires early intervention. Gunshot wounds can also cause penetrating thoracoabdominal injuries. We report the case of a 52-year-old male patient, a worker at a timber-processing factory, who was assaulted with a chainsaw by his colleague following a disagreement. He was seen at the accident and emergency department of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with a thoracoabdominal injury about 1.5 hours after the attack. He had a left thoracoabdominal laceration with abdominal evisceration and an open left pneumothorax. He was managed operatively, made a full recovery, and was discharged 16 days after admission. He was readmitted 4 months after the initial surgery with acute intestinal obstruction secondary to adhesions. He underwent exploratory laparotomy and adhesiolysis. He made an uneventful recovery and was discharged on the 9th postoperative day for subsequent follow-up., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (© 2022 The Korean Society of Traumatology.)

Rebars made of fiber-reinforced plastic (FRP) might be the future reinforcing material, replacing mild steel rebars, which are prone to corrosion. The bond characteristics of FRP rebars differ from those of mild steel rebars due to their different stress-strain behavior than mild steel. As a result, determining the bond strength (BS) qualities of FRP rebars is critical. In this work, BS data for FRP rebars was investigated, utilizing non-linear capabilities of gene expression programming (GEP) on 273 samples. The BS of FRP and concrete was considered a function of bar surface ( Bs ), bar diameter ( d b ), concrete compressive strength ( f c '), concrete-cover-bar-diameter ratio ( c / d ), and embedment-length-bar-diameter ratio ( l / d ). The investigation of the variable number of genetic parameters such as number of chromosomes, head size, and number of genes was undertaken such that 11 different models (M1-M11) were created. The results of accuracy evaluation parameters, namely coefficient of determination (R 2 ), mean absolute error (MAE), and root mean square error (RMSE) imply that the M11 model outperforms other created models for the training and testing stages, with values of (0.925, 0.751, 1.08) and (0.9285, 0.802, 1.11), respectively. The values of R 2 and error indices showed that there is very close agreement between the experimental and predicted results. 30 number chromosomes, 9 head size, and 5 genes yielded the optimum model. The parametric analysis revealed that d b , c / d , and l / d significantly affected the BS. The FRP rebar diameter size is greater than 10 mm, whereas a l / d ratio of more than 12 showed a considerable decrease in BS. In contrast, the rise in c / d ratio revealed second-degree increasing trend of BS.

Cement production is one of the major sources of decomposition of carbonates leading to the emission of carbon dioxide. Researchers have proven that incorporating industrial wastes is of paramount significance for producing green concrete due to the benefits of reducing cement production. The compressive strength of concrete is an imperative parameter to consider when designing concrete structures. Considering high prediction capabilities, artificial intelligence models are widely used to estimate the compressive strength of concrete mixtures. A variety of artificial intelligence models have been developed in the literature; however, evaluation of the modeling procedure and accuracy of the existing models suggests developing such models that manifest the detailed evaluation of setting parameters on the performance of models and enhance the accuracy compared to the existing models. In this study, the computational capabilities of the adaptive neurofuzzy inference system (ANFIS), gene expression programming (GEP), and gradient boosting tree (GBT) were employed to investigate the optimum ratio of ground-granulated blast furnace slag (GGBFS) and fly ash (FA) to the binder content. The training process of GEP modeling revealed 200 chromosomes, 5 genes, and 12 head sizes as the best hyperparameters. Similarly, ANFIS hybrid subclustering modeling with aspect ratios of 0.5, 0.1, 7, and 150; learning rate; maximal depth; and number of trees yielded the best performance in the GBT model. The accuracy of the developed models suggests that the GBT model is superior to the GEP, ANFIS, and other models that exist in the literature. The trained models were validated using 40% of the experimental data along with parametric and sensitivity analysis as second level validation. The GBT model yielded correlation coefficient (R), mean absolute error (MAE), and root mean square error (RMSE), equaling 0.95, 3.07 MPa, and 4.80 MPa for training, whereas, for validation, these values were recorded as 0.95, 3.16 MPa, and 4.85 MPa, respectively. The sensitivity analysis revealed that the aging of the concrete was the most influential parameter, followed by the addition of GGBFS. The effect of the contributing parameters was observed, as corroborated in the literature.

The development of self-compacting alkali-activated concrete (SCAAC) has become a hot topic in the scientific community; however, most of the existing literature focuses on the utilization of fly ash (FA), ground blast furnace slag (GBFS), silica fume (SF), and rice husk ash (RHA) as the binder. In this study, both the experimental and theoretical assessments using response surface methodology (RSM) were taken into account to optimize and predict the optimal content of ceramic waste powder (CWP) in GBFS-based self-compacting alkali-activated concrete, thus promoting the utilization of ceramic waste in construction engineering. Based on the suggested design array from the RSM model, experimental tests were first carried out to determine the optimum CWP content to achieve reasonable compressive, tensile, and flexural strengths in the SCAAC when exposed to ambient conditions, as well as to minimize its strength loss, weight loss, and UPVL upon exposure to acid attack. Based on the results, the optimum content of CWP that satisfied both the strength and durability aspects was 31%. In particular, a reasonable reduction in the compressive strength of 16% was recorded compared to that of the control specimen (without ceramic). Meanwhile, the compressive strength loss of SCAAC when exposed to acid attack minimized to 59.17%, which was lower than that of the control specimen (74.2%). Furthermore, the developed RSM models were found to be reliable and accurate, with minimum errors (RMSE < 1.337). In addition, a strong correlation ( R > 0.99, R 2 < 0.99, adj. R 2 < 0.98) was observed between the predicted and actual data. Moreover, the significance of the models was also proven via ANOVA, in which p -values of less than 0.001 and high F-values were recorded for all equations.

Background: Checkpoint kinase 1 (CHEK1), a DNA damage sensor and cell death pathway stimulator, is regarded as an oncogene in tumours, where its activities are considered essential for tumourigenesis and the survival of cancer cells treated with chemotherapy and radiotherapy. In breast cancer, CHEK1 expression has been associated with an aggressive tumour phenotype, the triple-negative breast cancer subtype, an aberrant response to tamoxifen, and poor prognosis. However, the relevance of CHEK1 expression has, hitherto, not been investigated in an indigenous African population. We therefore aimed to investigate the clinicopathological, biological, and prognostic significance of CHEK1 expression in a cohort of Nigerian breast cancer cases., Material and Methods: Tissue microarrays of 207 Nigerian breast cancer cases were tested for CHEK1 expression using immunohistochemistry. The clinicopathological, molecular, and prognostic characteristics of CHEK1-positive tumours were determined using the Chi-squared test and Kaplan-Meier and Cox regression analyses in SPSS Version 16., Results: Nuclear expression of CHEK1 was present in 61% of breast tumours and was associated with tumour size, triple-negative cancer, basal-like phenotype, the epithelial-mesenchymal transition, p53 over-expression, DNA homologous repair pathway dysfunction, and poor prognosis., Conclusions: The rate expression of CHEK1 is high in Nigerian breast cancer cases and is associated with an aggressive phenotype and poor prognosis.

Ku 70/80 is a regulator of the Non-Homologous End Joining (NHEJ) roles in clinicopathological features, and has prognostic significance in breast cancer (BC) in Caucasian populations. However, its significance in the Nigerian BC population, which is characterized by a higher rate of the triple-negative and basal phenotype, p53 mutation rate and BRCA1 deficiency, still needs to be investigated. We hypothesize that Ku70/80 expression shows adverse expression in Nigerian BC and, furthermore, that it is likely to have a therapeutic implication for Black BC management. This study investigated the biological, clinicopathological and prognostic significance of Ku 70/80 expression in a BC cohort from a Nigerian population. Ku 70/80 expression was determined in 188 well-characterized formalin-fixed, paraffin-embedded (FFPE) BC samples using tissue microarray and immunohistochemistry. Ku 70/80 expression was correlated with clinicopathological, molecular and prognostic characteristics of patients. Ku 70/80 was expressed in 113 (60.1%) tumors, and was positively associated with metastatic disease, triple-negative and basal phenotype, BRCA1 down regulators (MTA-1 and ID4), p-cadherin, PI3KCA and p53 expression. It inversely correlated with BRCA1, BRCA2, BARD1 and p27. Ku 70/80 was predictive of breast cancer-specific survival in multivariate analysis, but not of disease-free interval. This study demonstrated that Ku 70/80 expression is associated with triple negativity and down-regulation of the homologous recombination pathway of DNA repair. Therefore, the development of novel drugs to target KU70/80 may improve the patients' outcome in the treatment of Black BC., (Copyright © 2016. Published by Elsevier GmbH.)

Background: The prevalence of goitrous swelling has reduced in Nigeria since the introduction of salt iodisation programme. Thyroid disorders are the second most common endocrine disorder after diabetes mellitus worldwide. They present to general outpatient, medical and surgical clinics accompanied by great anxiety and poor health-related quality of life., Objectives: The study aimed to determine and describe the spectrum of thyroid disorders seen at Olabisi Onabanjo University Teaching Hospital over a 10-year period., Materials and Methods: This was a retrospective analysis of records of patients who presented to the hospital with thyroid swellings over a 10-year period (June 2004 to June 2014). Clinicopathological and demographic data obtained from hospital records in 175 patients diagnosed by clinical examination, thyroid ultrasound, hormone profile and histological confirmation in cases that had surgery were analysed for this study., Results: The records of 175 patients were obtained comprising 151 (86.3%) females and 24 (13.7%) males (female to male ratio of 6.3:1) with age range from 18 to 76 years and mean age of 42.3 years, standard deviation 13.5. With clinical diagnosis, distribution of thyroid diseases was simple goitre 103 (58.9%), toxic goitre 64 (36.6%), hypothyroidism 3 (1.7%), malignant goitre 4 (2.3%) and thyroiditis 1 (0.6%). The age group of 30-49 years had the highest prevalence of the thyroid diseases 100 (57.2%) while the extremes of age, below 20 and over 70 years had the least (5.1 and 2.9%, respectively)., Conclusion: The prevalent form of thyroid diseases seen at Olabisi Onabanjo University Teaching Hospital was simple goitre and most common in females. Studies on autoimmunity and other goitrogens are required to further elucidate the cause of this high prevalence.

Objective: To characterize the clinical features and pattern of presentation of breast diseases as observed in our practice., Materials and Methods: A prospective study of 121 consecutive patients with breast complaints presenting in our Surgical Outpatient Clinics. The relevant data were collected by two surgeons using the prescribed forms and was analyzed using Epi Info 2003, Mann-Whitney (test of two groups) Chi-squared and Fishers exact test was used to compare parameters of benign and malignant groups. P value <0.05 was considered as significant., Results: One hundred and nineteen patients were females, two were males. The age range was 14-70 years. Forty two (34.7%) patients were in the 21-30 year age group. The commonest symptoms were breast lump in 111 (91.7%) patients, and breast pain in 28 (23.1%) patients. Breast pain was a significant presenting complaint in patients with breast malignancy (P=.026). On clinical examination 103 (85.1%) patients had palpable lumps, and seven patients were normal. Forty four patients (36.3%) had malignant disease, seventy patients (57.8%) had benign breast diseases and seven were normal. Fifty nine of the 70 benign diseases were fibroadenoma. One hundred and three patients (85%) had appropriate therapy, while 18 patients (14.8%), including eight with malignant disease absconded., Conclusion: In the study, a breast lump was the commonest clinical feature of breast disease. Over 60% of these were benign. Breast pain was a statistically significant presentation in patients with malignant breast disease. One in seven of the patients absconded.

Background: Analgesic use, particularly opioids in the emergency situation in patients with acute abdominal pain, generally has been avoided in the past; however, newer evidence has shown that the practice should be encouraged. In spite of this, many physicians still withhold analgesics in this clinical situation., Aims: The aim of the study was to evaluate the current opinion and practice of Nigerian doctors regarding the use of analgesics for patients with acute abdominal pain during the initial evaluation., Methods: A one-page survey was distributed by two of the authors to Nigerian doctors from different parts of the country during conferences, seminars and meetings on different occasions in 2007. Demographic data and information regarding medical specialty, post-qualification experience, analgesic use in acute abdominal pain, and effects on diagnosis and outcome were included. The respondents were then classed into two sets of two groups using specialty (surgical and non-surgical) and post-qualification experience (less than 10 years, "less experienced;" over 10 years, "experienced")., Results: There were 539 respondents. The male:female ratio was 12:1. Of the respondents, 50.4% would withhold analgesics if the diagnosis was unclear, and a further 12% would do the same if a surgical opinion was required. Reasons for withholding analgesics were (1) believing that analgesics interfered with evolution of signs (84.4%), (2) believing that the diagnosis would be impaired (77.9%) and (3) believing that analgesics would have an adverse effect on outcome (54.5%). Specialty or length of post-qualification experience did not significantly influence this practice (p < 0.05)., Conclusion: The study has shown that the dogma that analgesics are harmful in patients with acute abdominal pain is still firmly entrenched in the practice of the surveyed Nigerian doctors. This belief is not significantly affected by specialty or post-qualification experience.

Background: Olabisi Onabanjo University Teaching Hospital is located in Sagamu, a suburban town with a population of 50,000 (1992 census). The hospital is a tertiary care facility in competition with a large number of private hospitals with different levels of competence., Objective: The objective of the study is to review the outcome of the surgical management of acute appendicitis in our hospital., Method: A retrospective study of subjects who had appendectomy for the clinical diagnosis of acute appendicitis between January 2002 and December 2004 was done., Result: 113 subjects consisting of 52 females (46%), and 61 males (54%) were studied. The mean age was 24.1 years, 71 subjects (62.9%) were in the 10-30 years range. 57.5% of the subjects were students and 71 subjects (62.8) resided in urban area. All the subjects, had generalized in 23.9%). The mean duration of symptoms was 3.53 days with standard deviation of 3.69 days. Only 3 subjects presented on the day of onset of symptoms. Only 15 subjects (13.3%) had surgery on the day of admission. 69subjects (61.1%) had uncomplicated inflamed appendix at surgery and 2 subjects (1.8%) had clinically normal appendix. The mean duration of hospital stay was 10.6 days with standard deviation of 7.4. The commonest postoperative complication was pyrexia in 16 subjects (14.2%), followed by wound infection in 12 subjects (10.6%). One subject died (0.9%)., Conclusion: The outcome reflects the late presentation and delay in surgical treatment.

The Queen Elizabeth II Hospital is the apex of the health care services in the Kingdom of Lesotho but has no designated burns unit. A review of patients managed during a 5-year period was done to document our experience so as to show what can be achieved even without a standard burns unit. We reviewed the clinical course of children who were admitted for care of acute thermal injuries during a 5-year period, May 1997 to April, 2002 inclusive. All were treated in the children surgical ward in accordance with a protocol of care emphasizing urgent care of shock, accurate fluid therapy, open wound care and early enteral feeding. Ninety-eight children (51 males and 47 females) aged 4 months to 43 months (mean 21.66 +/- 11.30 months) were admitted on account of acute thermal injuries during the study period. The injuries included scalding (46%) involving predominantly the upper part of the body and full thickness burns (87%). Skin grafting was needed in 82% of the patients. The common complications were infection, fluid imbalance, respiratory problems, and contracture deformities. The mean duration of hospital stay was 40 +/- 4.43 days and the case fatality rate was 9%. The case fatality rate in this series is considered high and could be improved if there were a well staffed specialized burns unit.

Syphilis is a notifiable and preventable disease, congenital syphilis more so. Consequently, attention has been recently focused on prenatal diagnosis of foetal syphilis by the use of ultrasonography apart from the conventional serologic screening. Congenital syphilis has not been reported from the Kingdom of Lesotho. We report the case of a 3.0 kg male neonate with florid joint and bone lesions of congenital syphilis associated with HIV infection seen at the Queen Elizabeth II Hospital, Maseru, Kingdom of Lesotho. Co-existing HIV infection influences the clinical manifestation of syphilis, the progression of neurosyphilis and the response to standard therapy. The baby had the recommended standard treatment with good response and he was followed-up for a period of twelve months with serologic screening and radiographic evaluation.

Intrapericardial (Pericardial) abscess is quite rare as a complication of sepsis and as a cardiac complication of typhoid septicaemia. It is rapidly fatal if untreated. We report two cases of a schoolboy eight years old with septicaemia from pyomyositis of the right thigh and another of nine and a half years with typhoid perforation and typhoid septicaemia that developed pericardial abscesses. In well-developed centres, computerised tomography, ultrasonography and other radiological investigations are employed for both diagnosis and therapy. We emphasise that these can be accomplished by good clinical examination, radiography of chest and the use of 18-G intra-venous cannula for percutaneous pericardiocentesis without aggressive surgical intervention.