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Objective: Vaccination rates among risk groups vary between different countries. There are gaps in the implementation of the acceptable recommended guidelines on adult pneumococcal immunization in Nigeria. This study aims to evaluate the barriers for physicians in recommending pneumococcal vaccines. Methods: This was a descriptive cross-sectional survey involving 97 physicians. Self-administered questionnaires were sent electronically to the physicians to understand the barriers to adult pneumococcal vaccine recommendations among adult physicians in Lagos. The sample size was based on estimation using the Cochrane formula. Results: Ninety-seven (97) physicians completed the questionnaire with a male to female ratio of 1:1.3. The mean age of the responders was 39.54±6.2 years. About 73(81.1%) of physicians recommended the pneumococcal vaccine and most physicians recommended the vaccine for patients with chronic lung diseases. The common barriers for vaccine recommendation include: unavailability (53; 54.6%), poor reminder systems (43; 44.3%), inadequate insurance coverage (33; 34%), and Vaccine shortage (31; 32%). Conclusions: This study suggests that the majority of physicians recommend pneumococcal conjugate vaccines. The major barriers to vaccination include poor access, availability, and cost. There is a need to increase access, cost, and availability of pneumococcal vaccine if the narrative must change.

Background: Lymphangioleiomyomatosis (LAM) is a rare disorder that presents in women of childbearing age. The affected patients present with spontaneous pneumothorax, chylothorax, hemoptysis, and slowly progressive dyspnea. There are poor awareness, knowledge, and records about this disease in Nigeria. Case presentation: We report a case of pulmonary LAM in a 43-year-old woman who presented with progressive shortness of breath with recurrent hemoptysis and pneumothorax. Her imaging and Vascular endothelial growth factor level were in keeping with LAM. The typical features in the current case include the patient's age, gender, radiologic features, and VEGF- D value. Conclusion: There is a need for a high index of suspicion for LAM in women of child-bearing age with cystic lung diseases. There is also a need for registries for rare lung diseases in Africa.

Objective: We aimed to describe the acute seizure care pathway for pediatric patients and identify barriers encountered by those involved in seizure care management. We also proposed interventions to bridge these care gaps within this pathway. Methods: We constructed a process map that illustrates the acute seizure care pathway for pediatric patients at Boston Children’s Hospital (BCH). The map was designed from knowledge gathered from unstructured interviews with experts at BCH, direct observation of patient care management at BCH through a quality improvement implemented seizure diary and from findings through three studies conducted at BCH, including a prospective observational study by the pediatric Status Epilepticus Research Group, a multi-site international consortium. We also reviewed the literature highlighting gaps and strategies in seizure care management. Results: Within the process map, we identified twenty-nine care gaps encountered by caregivers, care teams, residential and educational institutions, and proposed interventions to address these challenges. The process map outlines clinical care of a patient through the following settings: 1) pre-hospitalization setting, defined as residential and educational settings before hospital admission, 2) BCH emergency department and inpatient settings, 3) post-hospitalization setting, defined as residential and educational settings following hospital discharge or clinic visit and 4) follow-up BCH outpatient settings, including neurology, epilepsy, and primary care provider clinics. The acute seizure care pathway for a pediatric patient who presents with seizures exhibits at least twenty-nine challenges in acute seizure care management. Significance: Identification of care barriers in the acute seizure care pathway provides a necessary first step for implementing interventions and strategies in acute seizure care management that could potentially impact patient outcomes.

Theobroma cacao L. (Sterculiaceae) leaves have been used in folklore medicine as treatment for wound healing, worm expellers and malaria cure. In this study, the antioxidant and anthelmintic activities of aqueous and ethanolic extracts of the leaves of Theobroma cacao were investigated. The phytochemicals (tannins, phenols, saponins, terpenoids, flavonoids and glycosides) present in the leaves were determined using standard procedures. Antioxidant activities such as free radical scavenging and ferric reducing power of the aqueous and ethanolic extracts were determined. In vitro anthelmintic properties of the extracts were also investigated using adult earthworms (Pheretima posthuma) and the amount of time for paralysis and subsequently death was determined. Tannins, saponins, glycosides, phenol were found to be present in all the extracts, flavonoids were present in the ethanolic extract only. Aqueous extract (extracted at hot conditions) had higher DPPH scavenging activity with IC50 of 11.76 mg/mL while the ethanolic extract had higher ferric reducing power, total phenolic content and anthelmintic potential. All the extracts elicited significant anthelmintic activity comparable to that of standard drug (albendazole) with ethanolic extract showing lesser time taken to paralysis and death (14 ± 0.00 min and 16 ± 1.15 min respectively) for 50 mg/mL concentration. The presence of important phytochemicals and antioxidants in the leaves is a scientific justification of the traditional use of the plant in folklore medicine against various diseases affecting both humans and animals, especially as an anthelmintic.

Cancer is a disease at the cellular level involving heritable disorders in cellular control mechanism. Cancer cells also need to adapt their metabolism to survive and multiply under the metabolically compromised conditions provided by the tumor microenvironment. Tumor cells alter their metabolism to maintain unregulated cellular proliferation and survival, but this transformation leaves them reliant on constant supply of nutrients and energy. They alter their metabolism to support their rapid proliferation and expansion across the body. After the discovery of based on the altered cancer cell metabolism in 1930, loads of studies have shed light on several aspects of cancer metabolism with a common goal to find new ways for effectively eliminating tumor cells by targeting their energy metabolism. Research has directed most of its resources to elucidate the causes, prevention and possible cure for cancer, yet the process has been elusive claiming human lives more than ever. This disease is a manifestation of etiological and pathological disturbances of mechanisms that control cell division, differentiation and metabolism. 50% of all human tumors carry genetic alterations that lead to the inactivation of some tumor suppressor proteins. Cancer cells are shown to experience characteristic changes in their metabolic programs, including increased uptake of glucose, enhanced rates of glutaminolysis and fatty acids synthesis, suggesting that metabolic shifts supports tumor cells growth and survival. In this review, we summarized the major concepts of glucose metabolization and explore the molecular basis of aerobic glycolysis of cancer cells.

The aim of this study was to evaluate an automated trigger algorithm designed to detect potentially adverse events in children with Attention-Deficit/Hyperactivity Disorder (ADHD), who were monitored remotely between visits. We embedded a trigger algorithm derived from parent-reported ADHD rating scales within an electronic patient monitoring system. We categorized clinicians’ alert resolution outcomes and compared Vanderbilt ADHD rating scale scores between patients who did or did not have triggered alerts. A total of 146 out of 1738 parent reports (8%) triggered alerts for 98 patients. One hundred and eleven alerts (76%) required immediate clinician review. Nurses successfully contacted parents for 68 (61%) of actionable alerts; 46% (31/68) led to a change in care plan prior to the next scheduled appointment. Compared to patients without alerts, patients with alerts demonstrated worsened ADHD severity (β = 5.8, 95% CI: 3.5⁻8.1 [p < 0.001] within 90 days prior to an alert. The trigger algorithm facilitated timely changes in the care plan in between face-to-face visits.