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The management of a food supply chain is difficult and complex because of the product's short shelf-life, time-sensitivity, and perishable nature which must be carefully considered to minimize food waste. Temperature-controlled perishable food supply chain provides the highly crucial facilities necessary to maintain the quality and safety of the product. The storage temperature is the most vital factor in maintaining both the quality and shelf-life of a perishable food. Adequate storage temperature control ensures that perishable foods are transported to the end-users in good quality and safe to consume. This paper presents perishable food storage temperature control through mathematical optimal control model where the storage temperature is regarded as the control variable and the deterioration of the perishable food's quality follows the first-order reaction. The optimal storage temperature for a single perishable food is determined by applying the Pontryagin's maximum principle to solve the optimal control model problem. For multi-temperature commodities supply chain, an unsupervised machine learning (ML) method, called k-means clustering technique is used to determine the temperature clusters for a range of perishables. Based on descriptive analysis, it is observed that the k-means clustering technique is effective in identifying the best suitable storage temperature clusters for quality control of multi-commodity supply chain., (© 2024. The Author(s).)

In the Surveillance Tool for Outcome-based Comparison of FREEdom from infection (STOC free) project (https://www.stocfree.eu), a data collection tool was constructed to facilitate standardised collection of input data, and a model was developed to allow a standardised and harmonised comparison of the outputs of different control programmes (CPs) for cattle diseases. The STOC free model can be used to evaluate the probability of freedom from infection for herds in CPs and to determine whether these CPs comply with the European Union's pre-defined output-based standards. Bovine viral diarrhoea virus (BVDV) was chosen as the case disease for this project because of the diversity in CPs in the six participating countries. Detailed BVDV CP and risk factor information was collected using the data collection tool. For inclusion of the data in the STOC free model, key aspects and default values were quantified. A Bayesian hidden Markov model was deemed appropriate, and a model was developed for BVDV CPs. The model was tested and validated using real BVDV CP data from partner countries, and corresponding computer code was made publicly available. The STOC free model focuses on herd-level data, although that animal-level data can be included after aggregation to herd level. The STOC free model is applicable to diseases that are endemic, given that it needs the presence of some infection to estimate parameters and enable convergence. In countries where infection-free status has been achieved, a scenario tree model could be a better suited tool. Further work is recommended to generalise the STOC free model to other diseases.

Introduction: Stunning recent increases in subdermal contraceptive implant use, especially in sub-Saharan Africa, necessitate availability of quality implant removal services. In Nigeria, service delivery capacity and coverage for removal are lacking, despite strong government commitment and rapid uptake; there is a dearth of knowledge about barriers to quality implant removals in Nigeria., Methods: To determine access to and quality of contraceptive implant removal services, a landscape assessment was conducted in two states in Nigeria, focusing on four conditions for quality delineated in the Global Implant Removals Task Force framework. This mixed-methods approach integrated results from a desk review, a survey of health facilities and family planning managers, review of implant service statistics, and key informant interviews with providers and diverse stakeholders., Results: Seventy percent of providers ( N  = 21 of 30) had experienced problems performing implant removal, usually due to deeply inserted implants and equipment shortages. Providers had low confidence in performing removal and poor knowledge of implant removal steps. No facilities assessed had comprehensive equipment required for implant removal. Few facilities maintained systems or referral pathways to support difficult removals; difficult removals are absent from training manuals, and no formal trainings have been conducted. While most facilities collect data on removals, family planning dashboards do not capture it; few facilities use data for quality improvement., Conclusion: This study identified numerous challenges to quality implant removal, including poorly trained providers, inadequate supplies, underutilization of data on removals, and inability to manage difficult removals. As demand for implant removals skyrockets, providers need improved training in implant removal, appropriate job aids, supportive supervision, and effective procurement systems to ensure availability of supplies and equipment for removal. Tracking removals and reasons for removal in information systems and the Family Planning dashboard could sensitize providers to need for implant removals and improve data for decision-making in facilities and health systems., Competing Interests: The handling editor AEB declared a shared parent affiliation with the authors OnA, RH, and MC at the time of review., (© 2023 Adetiloye, Danladi, Haws, Anoke, Odio, Ugwa, Nganje, Enne, Afolabi, Adebola, Eze and Christofield.)

Background: There has been an increase in methamphetamine use across the globe, despite widespread control of the drug, prevention, and treatment. Community-based approaches have proven effective in tackling diverse health-related challenges including substance use; however, little is known regarding community programs targeting methamphetamine use. We conducted a systematic literature review on community programs aimed at tackling the use of methamphetamine across the globe., Method: Relevant literature from peer-reviewed and gray literature sources were systematically identified. A grid template was used to extract and synthesize findings from retrieved literature regarding themes of actors, actions, and outcomes related to identified programs., Results: A total of 19 documents met our inclusion criteria. Some of the dominant actors in efforts to reduce methamphetamine use in communities were local councils, drug enforcement units, influential persons in the community, people who use or had used methamphetamine, business corporations, and already-existing health promoting platforms. Actions taken were typically education/awareness/information campaigns. Drug enforcement agencies appeared to make little gains when acting alone, and appeared to drive dealers and users underground. Many of the efforts made at the community level were alluded to be beneficial; however, it was difficult to quantify the impact of programs. Community-level efforts also tended to cascade to other drugs., Conclusion: Community-based actors and actions are diverse and critical to the prevention of methamphetamine use. There is a need to better coordinate and integrate different actors and interventions so that outcomes can be better monitored and evaluated for greater effectiveness in reducing methamphetamine use., Competing Interests: Disclosure statement No potential conflict of interest was reported by the author(s).

Background: Palliative care aims to contribute to pain relief, improvement with regard to symptoms and enhancement of health-related quality of life (HRQoL) of patients with chronic conditions. Most of the palliative care protocols, programmes and units are predominantly focused on patients with cancer and their specific needs. Patients with non-cancer chronic conditions may also have significantly impaired HRQoL and poor survival, but do not yet receive appropriate and holistic care. The traditional focus of palliative care has been at the end-of-life stages instead of the relatively early phases of serious chronic conditions. The 'Patient-centred pathways of early palliative care, supportive ecosystems and appraisal standard' (InAdvance) project implements and evaluates early palliative care in the daily clinical routine addressing patients with complex chronic conditions in the evolution towards advanced stages. The objective of the current study is to evaluate the acceptability, feasibility, effectiveness and cost-effectiveness of this novel model of palliative care in the relatively early phases in patients with chronic conditions., Methods: In this study, a single blind randomised controlled trial design will be employed. A total of 320 participants (80 in each study site and 4 sites in total) will be randomised on a 1:1 basis to the Palliative Care Needs Assessment (PCNA) arm or the Care-as-Usual arm. This study includes a formative evaluation approach as well as a cost-effectiveness analysis with a within-trial horizon. Study outcomes will be assessed at baseline, 6 weeks, 6 months, 12 months and 18 months after the implementation of the interventions. Study outcomes include HRQoL, intensity of symptoms, functional status, emotional distress, caregiving burden, perceived quality of care, adherence to treatment, feasibility, acceptability, and appropriateness of the intervention, intervention costs, other healthcare costs and informal care costs., Discussion: The InAdvance project will evaluate the effect of the implementation of the PCNA intervention on the target population in terms of effectiveness and cost-effectiveness in four European settings. The evidence of the project will provide step-wise guidance to contribute an increased evidence base for policy recommendations and clinical guidelines, in an effort to augment the supportive ecosystem for palliative care., Trial Registration: ISRCTN, ISRCTN24825698 . Registered 17/12/2020., (© 2022. The Author(s).)

Abstract: The health and economic burden of foodborne illness is high, with approximately 2.4 million cases occurring annually in the United Kingdom. A survey to understand the baseline microbial quality and prevalence of food-related hazards of fresh beef mince on retail sale could inform risk assessment, management, and communication to ensure the safety of this commodity. In such a survey, a two-stage sampling design was used to reflect variations in population density and the market share of five categories of retail outlets in Scotland. From January to December 2019, 1,009 fresh minced beef samples were collected from 15 geographic areas. The microbial quality of each sample was assessed using aerobic colony count and Escherichia coli count. Samples were cultured for Campylobacter and Salmonella, and PCR was used to detect target genes (stx1 all variants, stx2 a to g, and rfbO157) for Shiga toxin-producing E. coli (STEC). The presence of viable E. coli O157 and STEC in samples with a positive PCR signal was confirmed via culture and isolation. Phenotypic antimicrobial sensitivity patterns of cultured pathogens and 100 E. coli isolates were determined, mostly via disk diffusion. The median aerobic colony count and E. coli counts were 6.4 × 105 (interquartile range, 6.9 × 104 to 9.6 × 106) and <10 CFU/g (interquartile range, <10 to 10) of minced beef, respectively. The prevalence was 0.1% (95% confidence interval [CI], 0 to 0.7%) for Campylobacter, 0.3% (95% CI, 0 to 1%) for Salmonella, 22% (95% CI, 20 to 25%) for PCR-positive STEC, and 4% (95% CI, 2 to 5%) for culture-positive STEC. The evidence for phenotypic antimicrobial resistance detected did not give cause for concern, mainly occurring in a few E. coli isolates as single nonsusceptibilities to first-line active substances. The low prevalence of pathogens and phenotypic antimicrobial resistance is encouraging, but ongoing consumer food safety education is necessary to mitigate the residual public health risk., (Published 2022 by the International Association for Food Protection.)

Background: Asthma symptoms are often mediated by changes in immune responses to allergens measured by the levels of immunoglobulin E (IgE) and non-protein regulators such as 25-hydroxycholecalciferol (25 (OH) vitamin D3). The relationship between serum levels of IgE, 25 (OH) Vitamin D3, and asthma control in asthma patients remains unclear., Objective: To measure the serum IgE and 25 (OH) vitamin D3 levels in asthma patients and determine their relationship with patient's asthma control., Methods: This was a cross-sectional study of children and adults with asthma aged 5 to 60 years old; and their controls seen in a tertiary hospital in Enugu, south eastern Nigeria from October 2018 to January 2019. Serum levels of IgE, and 25 (OH) vitamin D3 were determined by sandwich enzyme-linked immunosorbent assay (ELISA); and compared between groups using the Student's t-tests. Association between IgE, 25 (OH) vitamin D3 levels, and asthma control were determined using the Chi-square., Results: Sixty-five (65) asthma patients and thirty-three (36) non-asthma controls were studied. Mean serum level of IgE (411.32± 220.18 IU/ml) was significantly raised in asthma patients compared to controls (163.51 ± 186.36 lU/ml); p=0.001. There was no significant difference in mean 25 (OH) vitamin D3 levels in asthma (68.55 ± 25.91 ng/ml) compared to controls (77.25 ± 34.01 ng/ml); p=0.153. No significant association was found between patient's asthma control status, and serum IgE and 25 (OH) vitamin D3 levels., Conclusion: Asthma control status was not associated with Immunoglobulin E and 25 (OH) vitamin D3 levels in those studied. More robust study is required to evaluate the relationship between asthma control, IgE and vitamin D levels., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Countries have implemented control programmes (CPs) for cattle diseases such as bovine viral diarrhoea virus (BVDV) that are tailored to each country-specific situation. Practical methods are needed to assess the output of these CPs in terms of the confidence of freedom from infection that is achieved. As part of the STOC free project, a Bayesian Hidden Markov model was developed, called STOC free model, to estimate the probability of infection at herd-level. In the current study, the STOC free model was applied to BVDV field data in four study regions, from CPs based on ear notch samples. The aim of this study was to estimate the probability of herd-level freedom from BVDV in regions that are not (yet) free. We additionally evaluated the sensitivity of the parameter estimates and predicted probabilities of freedom to the prior distributions for the different model parameters. First, default priors were used in the model to enable comparison of model outputs between study regions. Thereafter, country-specific priors based on expert opinion or historical data were used in the model, to study the influence of the priors on the results and to obtain country-specific estimates. The STOC free model calculates a posterior value for the model parameters (e.g. herd-level test sensitivity and specificity, probability of introduction of infection) and a predicted probability of infection. The probability of freedom from infection was computed as one minus the probability of infection. For dairy herds that were considered free from infection within their own CP, the predicted probabilities of freedom were very high for all study regions ranging from 0.98 to 1.00, regardless of the use of default or country-specific priors. The priors did have more influence on two of the model parameters, herd-level sensitivity and the probability of remaining infected, due to the low prevalence and incidence of BVDV in the study regions. The advantage of STOC free model compared to scenario tree modelling, the reference method, is that actual data from the CP can be used and estimates are easily updated when new data becomes available., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers., Aim: The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits., Subjects and Methods: Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P < 0.05., Results: Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time., Conclusion: Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children., Competing Interests: None

Background: Many caregivers experience significant psychological burden which may impact on the management of a sick child., Objective: To determine the prevalence and associated factors of psychological distress among caregivers of children admitted at the Children Emergency Room., Methods: This was a descriptive cross-sectional study among caregivers of children who were hospitalized for at least 24 hours. The 28-item General Health Questionnaire (GHQ 28) was used to assess the psychological distress among the caregivers. GHQ scores were stated as means ± standard deviation (SD). Chi-square or Fisher's exact test was used to test for association between sociodemographic variables and psychological distress. Mean GHQ scores in the various domains of psychological dysfunction were compared among groups using the independent sample t-test; at p<0.05., Results: Of the 97 caregivers who participated in the study, 96 had their data analyzed. The caregivers were aged 19 to 63 (mean 34.25 (8.46)) years; 86 (89.7%) were females and 48 (50%) had tertiary education. The prevalence of psychological distress among the care givers was 69.8%. Caregivers had high levels of anxiety but low levels of depression. Those with lower educational attainment had higher scores on severe depression domain (p = 0.001). Unemployed caregivers had higher mean scores on the anxiety/insomnia (p = 0.039) and social dysfunction domains (p = 0.031). Those with large family sizes scored higher on the anxiety/insomnia domain (p = 0.03)., Conclusion: Psychological distress was high among caregivers of children admitted at the children emergency room., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Background: Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time., Objective: This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic., Methods: NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6)., Results: Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI -0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI -0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI -0.11 to 0.46), and mental well-being (vs MPS: Cohen d=-0.04, 95% CI -0.62 to -0.08; vs NHSWBP: Cohen d=-0.15, 95% CI -0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group., Conclusions: Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments., Trial Registration: ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122., (©Johannes H De Kock, Helen Ann Latham, Richard G Cowden, Breda Cullen, Katia Narzisi, Shaun Jerdan, Sarah-Anne Munoz, Stephen J Leslie, Andreas Stamatis, Jude Eze. Originally published in JMIR Mental Health (https://mental.jmir.org), 04.04.2022.)

Targeted empirical antibiotic therapy based on local microbiology and antibiotic resistance patterns is essential for the treatment of empyema thoracis. Our retrospective review of 105 pleural empyema culture and sensitivity reports aimed at determining the causative microorganisms and their antimicrobial resistance pattern. Of 105 pleural aspirate samples, 46 (43.8%) were positive on culture. Gram-negative organisms (n = 43) were the predominant isolates, the commonest of which was Klebsiella pneumoniae . It was concluded that empyema thoracis is predominantly caused by Gram-negative organisms in our locality. This should guide protocols on the initiation of empirical therapy.

Aims and Method: To characterise police involvement with those detained under place of safety legislation and determine factors associated with admission to hospital. Place of safety referrals over a 1-year period were identified retrospectively and evaluated., Results: Place of safety legislation is generally used with regard to concerns about suicide. Individuals are often removed from high-risk areas and referrals to police are frequently initiated by individuals themselves. A diagnosis of mental illness or personality disorder predicted hospital admission. Presence of senior nursing staff at assessment, but not the seniority of the doctor, was associated with discharge., Clinical Implications: Closer multiagency working is required as police are currently being recruited to fill a void between mental health services and the population they serve. Junior doctors require more senior support in making complex, and often risky, emergency management decisions with this population.

Joint optimal subcarrier and transmit power allocation with QoS guarantee for enhanced packet transmission over Cognitive Radio (CR)-Internet of Vehicles (IoVs) is a challenge. This open issue is considered in this paper. A novel SNBS-based wireless radio resource scheduling scheme in OFDMA CR-IoV network systems is proposed. This novel scheduler is termed the SNBS OFDMA-based overlay CR-Assisted Vehicular NETwork (SNO-CRAVNET) scheduling scheme. It is proposed for efficient joint transmit power and subcarrier allocation for dynamic spectral resource access in cellular OFDMA-based overlay CRAVNs in clusters. The objectives of the optimization model applied in this study include (1) maximization of the overall system throughput of the CR-IoV system, (2) avoiding harmful interference of transmissions of the shared channels' licensed owners (or primary users (PUs)), (3) guaranteeing the proportional fairness and minimum data-rate requirement of each CR vehicular secondary user (CRV-SU), and (4) ensuring efficient transmit power allocation amongst CRV-SUs. Furthermore, a novel approach which uses Lambert-W function characteristics is introduced. Closed-form analytical solutions were obtained by applying time-sharing variable transformation. Finally, a low-complexity algorithm was developed. This algorithm overcame the iterative processes associated with searching for the optimal solution numerically through iterative programming methods. Theoretical analysis and simulation results demonstrated that, under similar conditions, the proposed solutions outperformed the reference scheduler schemes. In comparison to other scheduling schemes that are fairness-considerate, the SNO-CRAVNET scheme achieved a significantly higher overall average throughput gain. Similarly, the proposed time-sharing SNO-CRAVNET allocation based on the reformulated convex optimization problem is shown to be capable of achieving up to 99.987% for the average of the total theoretical capacity.

Aims: This study was carried out to evaluate the degree of accuracy of age-based weight estimation methods in assessing the weight of the Nigerian child., Method: The weights of one thousand, four hundred and fifty-six (1,456) children were measured and compared with the updated Advanced Paediatric Life Support (APLS), Best guess, Nelson and Luscombe & Owen methods., Result: The updated APLS, Nelson and Luscombe & Owen methods underestimated the weights in younger children while overestimating in older ones. Best guess overestimated the weights across all ages. The Nelson formula had the best agreement within 10% and 20% of the measured weights among all methods. A linear regression analysis produced an equation for weight estimation: weight (W) = 2.058 Y + 9.925, where W is weight in kilogram and Y is the age in years., Conclusion: None of the weight estimation formulae assessed was entirely accurate in our study, though the Nelson method showed superior agreement., Competing Interests: None

Research into, and the use of plant products in the control of vectors of pathogens is being revived and seriously considered as an alternative or complete replacement for the classical synthetic agents. The study was designed to investigate toxicological assessment of the aqueous leaf extract of Vernonia amygdalina on mortality and tissue level damages of the freshwater snail Bulinus truncatus at different pH levels. The effects of the extract on total protein concentration and activities of acetylcholinesterase, acid phosphatase and alkaline phosphatase in the tissues of the snail were assayed using standard methods. Compared to the control (snail group not treated with the extract of V. amygdalina ), there were significant (p < 0.05) reductions in the total protein concentrations and acetylcholinesterase activity in the snails' tissues of the treated groups (0.20 mg/L, 0.40 mg/L and 1.00 mg/L) at all the pH conditions (3.5, 7.0 and 10.5). The reverse of this trend followed in the case of acid and alkaline phosphatases' activities. The study provides a substantial possibility of exploiting local indigenous plant resources such as V. amygdalina for control of freshwater snails and monitor water pollution. The study also raised a possibility of the locals living around freshwater bodies prone to trematode borne diseases to reflexively control freshwater snail population by just squeeze-washing their V. amygdalina around the river banks., (© 2020 The Authors.)

Background: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin., Case Description: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery., Discussion: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days., Conclusion: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: For children with cancer, the clinical integration of precision medicine to enable predictive biomarker-based therapeutic stratification is urgently needed., Methods: We have developed a hybrid-capture next-generation sequencing (NGS) panel, specifically designed to detect genetic alterations in paediatric solid tumours, which gives reliable results from as little as 50 ng of DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissue. In this study, we offered an NGS panel, with clinical reporting via a molecular tumour board for children with solid tumours. Furthermore, for a cohort of 12 patients, we used a circulating tumour DNA (ctDNA)-specific panel to sequence ctDNA from matched plasma samples and compared plasma and tumour findings., Results: A total of 255 samples were submitted from 223 patients for the NGS panel. Using FFPE tissue, 82% of all submitted samples passed quality control for clinical reporting. At least one genetic alteration was detected in 70% of sequenced samples. The overall detection rate of clinically actionable alterations, defined by modified OncoKB criteria, for all sequenced samples was 51%. A total of 8 patients were sequenced at different stages of treatment. In 6 of these, there were differences in the genetic alterations detected between time points. Sequencing of matched ctDNA in a cohort of extracranial paediatric solid tumours also identified a high detection rate of somatic alterations in plasma., Conclusion: We demonstrate that tailored clinical molecular profiling of both tumour DNA and plasma-derived ctDNA is feasible for children with solid tumours. Furthermore, we show that a targeted NGS panel-based approach can identify actionable genetic alterations in a high proportion of patients., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Determining the Bovine Viral Diarrhoea (BVD) infection status of cattle herds is a challenge for control and eradication schemes. Given the changing dynamics of BVD  virus (BVDV) antibody responses in cattle, classifying herds based on longitudinal changes in the results of BVDV antibody tests could offer a novel, complementary approach to categorising herds that is less likely than the present system to result in a herd's status changing from year to year, as it is more likely to capture the true exposure dynamics of the farms. This paper describes the dynamics of BVDV antibody test values (measured as percentage positivity (PP)) obtained from 15,500 bovines between 2007 and 2010 from thirty nine cattle herds located in Scotland and Northern England. It explores approaches of classifying herds based on trend, magnitude and shape of their antibody PP trajectories and investigates the epidemiological similarities between farms within the same cluster. Gaussian mixture models were used for the magnitude and shape clustering. Epidemiologically meaningful clusters were obtained. Farm cluster membership depends on clustering approach used. Moderate concordance was found between the shape and magnitude clusters. These methods hold potential for application to enhance control efforts for BVD and other infectious livestock diseases.

Background: Allergic diseases are known to occur in children with asthma and its coexistence with asthma may impact on asthma control in affected children living in a low-income country. The study is to determine the allergic profile of children with asthma and the association with asthma control and attendant social risk factors., Materials and Methods: This was a cross-sectional study of consecutively enrolled children with physician diagnosed asthma, attending clinics in a tertiary center in Nigeria. The presence of asthma, allergy types, and asthma control levels were determined using the Gobal initiative on asthma (GINA), international study of asthma and allergy in childhood and asthma control test questionnaires, respectively., Results: There were 207 children with asthma enrolled from the Pediatric Asthma Clinic at University of Nigeria Teaching Hospital, Enugu. The median age was 10 years and interquartile range of 7-11 years. There were 127 (61.4%) from middle and high socioeconomic class and 86.5% who lived in the urban areas. Of the study participants, 41.5% had one or more allergy symptoms; rhinitis (33.3%), conjunctivitis (29.0%), and dermatitis (7.2%). Allergy symptoms persisted from infancy in 55.9%. Children from large families had a lower prevalence of allergies. Having any allergy symptom and belonging to a small-sized family were both associated with asthma exacerbations. Most children studied, (69.1%) had their asthma under control. Allergy persistence from infancy and type of allergy were not significantly associated with the level of asthma control., Conclusion: Allergic diseases are common in children with asthma in our environment, but did not significantly impact on asthma control. Socioeconomic factors such as urbanization and family size had effects on the achievement of asthma control but not on allergy status., Competing Interests: There are no conflicts of interest

Collection of abattoir data related to public health is common worldwide. Standardised on-going programmes that collect information from abattoirs that inform producers about the presence and frequency of disease that are important to them rather than public health hazards are less common. The three voluntary pig health schemes, implemented in the United Kingdom, are integrated systems which capture information on different macroscopic disease conditions detected in slaughtered pigs. Many of these conditions have been associated with a reduction in performance traits and consequent increases in production costs. The schemes are the Wholesome Pigs Scotland in Scotland, the British Pig Health Scheme in England and Wales and the Pig Regen Ltd. health and welfare checks in Northern Ireland. In this study, four post mortem conditions (pericarditis, milk spots, papular dermatitis and tail damage) were surveyed and analysed over a ten and half year period, with the aim to compare the prevalence, monthly variations, and yearly trends between schemes. Liver milk spot was the most frequently recorded condition while tail damage was the least frequently observed condition. The prevalence of papular dermatitis was relatively low compared to liver milk spot and pericarditis in the three schemes. A general decreasing trend was observed for milk spots and papular dermatitis for all three schemes. The prevalence of pericarditis increased in Northern Ireland and England and Wales; while Scotland in recent years showed a decreasing trend. An increasing trend of tail damage was depicted in Scotland and Northern Ireland until 2013/2014 followed by a decline in recent years compared to that of England and Wales with a decreasing trend over the full study period. Monthly effects were more evident for milk spots and papular dermatitis. Similarity of the modus operandi of the schemes made the comparison of temporal variations and patterns in gross pathology between countries possible over time, especially between countries with similar pig production profile. This study of temporal patterns enables early detection of prevalence increases and alerts industry and researchers to investigate the reasons behind such changes. These schemes are, therefore, valuable assets for endemic disease surveillance, early warning for emerging disease and also for monitoring of welfare outcomes., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Physical growth of a child is a reflection of its state of nutrition. In some developing countries such as Nigeria with changing economy and rapidly growing population, the nutritional status of the children is a reflection of the general well-being of the society., Materials and Methods: This was a descriptive cross-sectional study in which participants were selected using a multistage sampling method. Heights and weights of randomly selected school children aged 6-12 years were measured using standard protocols. Weight-for-age, height-for-age, and body mass index (BMI)-for-age expressed as Z-scores were used to characterize the nutritional status. Descriptive statistics was used to determine the frequency and standard deviations (SDs) of the anthropometric measurements. Age and gender differences in the mean body weight, height, and BMI were evaluated using an independent samples t-test. Significant levels were set at P< 0.05., Results: A total of 1305 males and 1311 females were enrolled in the study. The mean age was 8.9 ± 1.9 years. Their mean height, weight, and BMI were 136.6 ± 10.2 cm, 29.7 ± 7.7 kg, 15.7 ± 2.4 kg/m2, respectively. Their mean ± SD scores of the WAZ, HAZ, and BAZ were 0.33 ± 1.20, 0.78 ± 1.17, and - 0.51 ± 1.27, respectively. A majority (78.9%, 2090/2616) were in the normal growth category. Wasting, overweight, obesity, underweight, and stunting were noted in 9.3% (243/2616), 6.3% (166/2616), 4.4% (117/2616), 0.9% (26/2616), and 0.4% (13/2616) of the children, respectively. Wasting was more in males (P = 0.069), and overweight was more in females (P = 0.138)., Conclusion: A majority of the children have normal growth with the remainder in both extremes of malnutrition. Institution of school-feeding programs in all Nigerian schools as well as nutrition education/campaign directed at parents and their children will help forestall the double burden of under- and over-nutrition among our children.

Background: Ear related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children., Objective: To determine the prevalence of ear-related problems among children presenting at the Paediatric and Otorhinolaryngology clinics of the University of Nigeria Teaching Hospital, Enugu., Materials and Methods: This was a cross-sectional study conducted at the Paediatric and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital Enugu. All children aged 0 and 17 years presenting between 1(st) June and 31(st) August 2006 with ear-related problems were enrolled consecutively into the study. Data analysis was by SPSS version 11., Results: Three thousand and twenty-one children were seen during the study period. Out of these, 248 children (8.2%) presented with ear-related problems. Chronic otitis media (30.5%), acute otitis media (29.9%), cerumen auris (11.3%), otitis externa (10.1%), hearing impairment (7.3%) and foreign body in the ear (5.7%) were the most commonly diagnosed ear-related problems., Conclusion: Ear-related problems among children presenting at the UNTH Enugu were not uncommon. However, otitis media was the most commonly diagnosed ailment affecting the ears in children.

Background: Wildlife can be important sources and reservoirs for pathogens. Trypanosome infections are common in many mammalian species, and are pathogenic in some. Molecular detection tools were used to measure trypanosome prevalence in a well-studied population of wild European badgers (Meles meles)., Findings: A nested ITS-PCR system, that targeted the ribosomal RNA gene locus, has been widely used to detect pathogenic human and animal trypanosomes in domestic animals in Africa and some wildlife hosts. Samples from a long-term DEFRA funded capture-mark-recapture study of wild badgers at Woodchester Park (Gloucestershire, SW England) were investigated for trypanosome prevalence. A total of 82 badger blood samples were examined by nested ITS-PCR. Twenty-nine of the samples were found to be positive for trypanosomes giving a prevalence of 35.4% (25.9% - 46.2%; 95% CI). Infection was not found to be linked to badger condition, sex or age. Analysis of DNA sequence data showed the badgers to be infected with Trypanosoma (Megatrypanum) pestanai and phylogenetic analysis showed the Woodchester badger trypanosomes and T. pestanai to cluster in the Megatrypanum clade., Conclusions: The results show that the ITS Nested PCR is an effective tool for diagnosing trypanosome infection in badgers and suggests that it could be widely used in wildlife species with unknown trypanosomes or mixed infections. The relatively high prevalence observed in these badgers raises the possibility that a significant proportion of UK badgers are naturally infected with trypanosomes.

Background: Blood pressure (BP) is a reflection of hemodynamic variables. It is an important vital sign and indicator of clinical stability. Accurate measurement of this physiological signal is essential for the optimal management of the ill infant. An increase in the awareness of hypertension among neonates has resulted to increased ability to diagnose neonates with the disease., Objectives: This study aimed to determine BP values in apparently healthy term newborns in the first 48 h of life and evaluate the factors affecting BP at birth., Methods: Three hundred and ten healthy appropriate for gestational age term newborns were consecutively recruited. BP measurements were determined using the oscillometric technique with the neonate supine after an appropriate size cuff was applied on the right arm. The monitor (Dinamap 8100) is switched on while the cuff inflation and deflation is automatically done by the instrument with subsequent display of the BP values on the screen. BP measurements were taken at age 0-24 h and 25-48 h. Their weight was measured with infant's weighing scale, and data analyzed with SPSS version 15., Results: The mean systolic BP (SBP), diastolic and mean arterial BP at 0-24 h were 63.3 ± 5.5 mmHg, 36.8 ± 5.3 mmHg and 46.4 ± 5.2 mmHg respectively. There was a positive correlation between birth weight and SBP at birth. No significant correlation was found between BP and gender, mode of delivery or maternal age., Conclusion: This study provides current normative BP values that can be used in neonatal Intensive Care Unit.

Zinc is an essential trace element crucial for normal development and function of cells mediating nonspecific immunity and protects bio-molecules from oxidative damage. This study was designed to assess the effects of dietary zinc supplementation on anaemia and immunity of trypanosome-infected rats. Thirty rats, divided into five groups (A-E) of 6 each, were used for the study. Parameters used to assess the effect of the supplementation are antibody response to Sheep RBC using direct haemagglutination test, parasitaemia using the rapid matching method, WBC count using the improved Neubauer haemocytometer method, haemoglobin concentration using the cynomethaemoglobin technique while PCV was determined using the microhaematocrit method. The pre-infection supplementation did not prolong the pre-patent period significantly (p > 0.05). However, it significantly (p < 0.05) increased the packed cell volume (PCV), haemoglobin (Hb) concentration, leucocyte count, and antibody titre by day 7 on the supplementation (OTS). Following infection on day 7 OTS, the PCV and Hb decreased but remained significantly (p < 0.05) higher than the infected not supplemented (INS) group, while on day 14 OTS, they maintained a significantly (p < 0.05) higher antibody titre as compared to other groups. On day 21 OTS, theweight of 8 ppm and not infected not supplemented (NINS) groups was significantly (p < 0.05) higher but the relative organ weight of their liver and spleen was significantly (p < 0.05) lower than 2 ppm, 4 ppm and INS groups. On day 21 OTS, the parasitaemia levels of INS group was significantly (p < 0.05) higher than the supplemented groups. From the results, dietary zinc supplementation can be useful in the management of anaemia and immunosupression caused by trypanosomes in rats., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A true aneurysm is defined as an enlargement of an artery resulting in a diameter more than 1.5 times the anatomic size. It can be fusiform when it covers the entire perimeter of the vessel, or saccular when it bulges on one side of the artery. The pseudoaneurysm is a pulsating encapsulated haematoma in communication with the lumen of the ruptured vessel,which affects the the intima and the media and which is stopped from developing by the adventitia and the surrounding connective tissue. Geographically, aneurysm can be broadly divided into intracranial and extracranial types.While the neurosurgeon manages the intracranial types, the vascular surgeon manages the extracranial types. Vascular surgeons also do divide the extracranial types into central (abdominal-aorto-iliac, thoracic including ascending, transverse aortic arch and descending), peripheral (extremities) and visceral (splanchnic arteries). Splanchnic artery aneurysm includes the coeliac, superior mesenteric, inferior mesenteric arteries including their branches. Of all intra-abdominal aneurysms, only around 5% are due to the splanchnic arteries,which could be either true or pseudo. The prevalence has been estimated at 0.1-0.2%.

Surveillance of animal diseases provides information essential for the protection of animal health and ultimately public health. The voluntary pig health schemes, implemented in the United Kingdom, are integrated systems which capture information on different macroscopic disease conditions detected in slaughtered pigs. Many of these conditions have been associated with a reduction in performance traits and consequent increases in production costs. The schemes are the Wholesome Pigs Scotland in Scotland, the BPEX Pig Health Scheme in England and Wales and the Pig Regen Ltd. health and welfare checks done in Northern Ireland. This report set out to compare the prevalence of four respiratory conditions (enzootic pneumonia-like lesions, pleurisy, pleuropneumonia lesions and abscesses in the lung) assessed by these three Pig Health Schemes. The seasonal variations and year trends associated with the conditions in each scheme are presented. The paper also highlights the differences in prevalence for each condition across these schemes and areas where further research is needed. A general increase in the prevalence of enzootic pneumonia like lesions was observed in Scotland, England and Wales since 2009, while a general decrease was observed in Northern Ireland over the years of the scheme. Pleurisy prevalence has increased since 2010 in all three schemes, whilst pleuropneumonia has been decreasing. Prevalence of abscesses in the lung has decreased in England, Wales and Northern Ireland but has increased in Scotland. This analysis highlights the value of surveillance schemes based on abattoir pathology monitoring of four respiratory lesions. The outputs at scheme level have significant value as indicators of endemic and emerging disease, and for producers and herd veterinarians in planning and evaluating herd health control programs when comparing individual farm results with national averages.

Objective: To investigate the associations between time to presentation, and sociodemographic and clinical characteristics of new adult ophthalmic outpatients at the University of Nigeria Teaching Hospital (UNTH), Enugu, between March and August 2010., Study Design: Hospital-based case-control study., Methods: Consecutive new ophthalmic outpatients at UNTH were categorized into controls (early presenters, i.e. <3 months after onset of current eye disease) and cases (late presenters, i.e. >3 months after onset of current eye disease). Relevant data were obtained from the participants' case notes and interviews. Descriptive statistics yielded frequency distributions; bivariate and multivariate comparisons were used to test the significance of associations. P < 0.05 was considered to indicate significance., Results: Eight hundred and twenty-four subjects [454 males and 370 females, mean age 39.2 (standard deviation 1.2) years, range 19-82 years] participated in this study. There were 370 early presenters and 454 late presenters. Multivariate analysis found that late presentation was significantly associated with age >50 years [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.28-2.22; P < 0.01], female gender (OR 1.63, 95% CI 1.52-2.11; P < 0.01), residence >20 km from UNTH (OR 0.65, 95% CI 0.38-0.89; P = 0.0212), individual-level deprivation (OR 0.69, 95% CI 0.55-0.92; P = 0.0324) and subnormal visual acuity at presentation (OR 1.32, 95% CI 1.05-1.76; P = 0.0353)., Conclusions: At UNTH, most new adult ophthalmic outpatients present >3 months after onset of their current eye disease. Measures to overcome age-, gender- and distance-related causes of late presentation, grassroots economic empowerment of the feeder population and public education about eye health are required., (Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Intestinal helminthiasis is associated with malnutrition in children., Aim: The objective of this study was to determine the intensity and effect of the common intestinal helminths on the nutritional status of children in Enugu, Nigeria., Subjects and Methods: A cross-sectional study of 460 children conducted in Enugu metropolis, south-east Nigeria between August and September 2003. Their stools were analyzed at the research laboratory of the Federal Ministry of Health, National Arbovirus and Vector Research Center, Enugu. The intensity of the common intestinal helminths was determined using the standard Kato-Katz method of fresh stool samples. The classification intensity of helminthic infestation was according to the World Health Organization classification. Data were analyzed using Statistical Software for Social Sciences version 11.0 (Chicago IL, USA). P < 0.05 was regarded as statistically significant., Results: 452 of 460 children (98.3%) had normal height for age, weight for age and weight for height Z-scores. Six of the 460 children (1.3% were wasted), 1/460 stunted (0.2%) and 1/460 wasted and stunted (0.2%). 150 out of 460 (32.6%) studied were infected with helminths. There was no significant relationship between the intensity of helminth infection and the nutritional status of the children., Conclusion: Although the prevalence of helminthiasis in children in Enugu was high, intensity of helminthiasis in these children was mainly mild. Hence, majority of them had normal weight and height measurements for age and sex.

Summary: The associations with weather and bathing water quality on infectious intestinal disease (IID) were investigated using data from two Scottish NHS Board areas. Monthly counts of viral and non-viral gastrointestinal infections were modelled as a smooth function of temperature, relative humidity and average monthly counts of faecal indicator organisms, respectively, adjusting for season and long-term trend effects. Strong seasonal patterns were observed for each group of pathogens. Peak viral gastrointestinal infection was in May while that of non-viral gastrointestinal infections was in July. A statistically significant negative association existed between weather (temperature and humidity) and viral infection. Average levels of non-viral gastrointestinal infections increased as temperature and relative humidity increased. Increasing levels of faecal indicator organisms in bathing waters were also associated with an increase in the average number of viral and non-viral gastrointestinal infections at the ecological level. Future climate change and prolonged precipitation events may result in increasing levels of faecal indicator organisms in bathing waters leading to likely increases in IIDs.

Background: Aim of our study is to highlight technical details in pedicled right colon interposition locally in cases of long segment corrosive esophageal stricture. Lesion results from cicatrization of burns wound inflicted by chemicals. Restoration of swallowing is of paramount importance., Materials and Methods: It was a retrospective study involving adult and adolescent patients who had surgery because of corrosive esophageal stricture between January 2001 and December 2010. Hospital records were reviewed for age, sex, radiological findings, detail of anesthesia, operative procedure, and follow up. The steps which included mobilization of colon with intact marginal blood supply, safeguarding the middle colic artery that forms the pedicle, and doing three anastomoses that were leak proof were ascertained., Result: There were 12 males (70.5%) and six females (29.4%) and age ranged from 14 to 45 years. Caustic soda caused the problem among 10 (58.8%) patients while liquid acid battery was involved in three (17.6%) patients. The rest were distributed equally between native concoction and unknown substance. All were done under general anesthesia and mean duration of the procedure was 306.8 ± 54.6 min with an average intra operative blood loss of 823.1 ± 428.5 m. Sixteen (94.1%) had successful pedicle isolation and 15 (82.3%) patients had neither dysphagia nor reflux at follow-up., Conclusion: Securing a pedicled right colon based on middle colic artery was a critical step. This surgical technique should be used to restore swallowing among patients with long segment esophageal stricture.

Background: Globally, major chest injuries have both high morbidity and mortality. A detailed study of chest injuries in south-eastern Nigeria is here presented., Aims: To determine the incidence, the predisposing factors, the pattern of presentation and the outcome of management of chest injuries., Materials and Methods: This is a retrospective study spanning a period of 10 years (2002-2011). The medical records of all patients with documented chest injuries that presented to our hospital within the period under review, were retrieved and analysed, by simple arithmetic percentages., Result: A total of 402 patients (average of 40/year) with the age ranges in the spectrum of 0-10 and 81-90 years, with a mean of 2.2 were found. Gender-wise, 301 males (74.9%) and 101 females (25.1%) were affected. The aetiological or the predisposing factors were blunt chest injuries (61.2%) and penetrating chest injuries (38.8%). In the pattern of presentation, haemothorax (20.9%), haemopneumothorax (16.2%), pneumothorax (17.4%) including simple, open and tension types as well as multiple ribs fractures (7.7%) constituted the majority. In the management strategies, conservative methods were mainly used. The outcome ranged from very good to fair., Conclusion: The management of chest injuries in our sub-region like any other developing countries is very much challenging. Concerted efforts are needed to overcome the burden it imposes.

Background: Male gender preference is a dominant feature of Igbo culture and could be the reason behind women seeking fetal gender at ultrasound., Aim: The aim of this study is to investigate the perception of prenatal ultrasound patients of male gender preference in a patriarchal and gender sensitive society., Subjects and Methods: The study was a cross-sectional survey, which targeted pregnant women who presented for prenatal ultrasound at four selected hospitals in Anambra State. A convenience sample size of 790 pregnant women constituted the respondents. The data collection instrument was a 13-item semi-structured self-completion questionnaire designed in line with the purpose of the study. Descriptive and inferential statistical analyses were carried out with statistical significance being considered at P < 0.05., Results: Most of the women (88.4%, 698/790) were aware that fetal gender can be determined during the prenatal ultrasound while just over half of them (61.0%, 482/790) wanted fetal gender disclosed to them during prenatal ultrasound. More than half (58.6%, 463/790) of the women desired to have male babies in their present pregnancies while 20.1% (159/790) desired female babies and 21.3% (168/790) did not care if the baby was male or female. Some of the women (22.2%, 175/790) wanted to have male babies in their present pregnancies for various reasons predominant of which was protecting their marriages and cementing their places in their husbands' hearts. Male gender preference was strongly perceived. There was considerable anxiety associated with prenatal gender determination and moderate loss of interest in the pregnancy associated with disclosure of undesired fetal gender. Socio-demographic factors had significant influence on perception of male gender preference., Conclusion: Male gender preference is strongly perceived among Igbo women and its perception is significantly influenced by socio-demographic factors. Male gender preference may be responsible for Igbo women seeking fetal gender at ultrasound.

Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from place to place., Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State over a 5-year period (January 2007-June 2012) was undertaken., Results: Thirty one thousand seven hundred and ninety-five (31,795) children attended the outpatient clinic of the hospital over the study period, of these, 65 had cardiac diseases, from which 16 were found to have congenital complex cardiac abnormalities of various types, giving a prevalence of 0.05%. Complex abnormalities seen in these children are Tricuspid atresia with various associations, cor triatriatum, single ventricle, and large ASD (atrio-septal defect) with complete AVCD, cor triatriatum sinistrum with cardiomyopathy, DORV (double outlet right ventricle) with left sided aorta, hypoplastic tricuspid valve with a PDA (patent ductus artriosus), TOF (tetralogy of fallot), prolapse of aortic valve, and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association., Conclusions: The results of this study show that 0.05% of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF.

Trypanosomosis has been associated with immunosuppression, anemia and oxidative damage while selenium possesses both immunostimulatory and antioxidative effects. This study was designed to assess the effect of dietary selenium supplementation on parasitemia, anemia, survival pattern and serum protein profiles of trypanosome-infected rats. Twenty five rats, divided into five groups (A-E) of 5 each, were treated as follows: 4, 8 and 16 ppm (ppm) of selenium in their feed, respectively throughout the experimental period and were infected with Trypanosoma brucei brucei on day 14 post supplementation, infected not supplemented and the negative control. Supplementation at 4 and 8 ppm increased the packed cell volume (PCV) and hemoglobin (Hb) concentration on day 7 of supplementation (PS) when compared with the unsupplemented groups. Following infection on day 14 PS, the PCV, Hb of 16 ppm and infected not supplemented groups were significantly (P < 0.05) lower than other groups on days 28 and 35 PS. Supplementation did not lead to significant (P > 0.05) changes on the total protein, albumin and globulin by day 14 PS. Infection, however, caused significant (P > 0.05) decrease in the total protein and albumin from day 28. The supplementation did not significantly (P > 0.05) increase the pre-patent period but caused a significant reduction in the parasitemia levels and increased survival intervals. Dietary selenium supplementation, from the results, may show promise in the management of African trypanosomosis as the supplementation was able to: reduce anemia and parasitemia and increase survival intervals of trypanosome infected rats., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The immunomodulatory effect of the probiotic (Saccharomyces cerevisiae) on Trypanosoma brucei brucei infected rats was studied. Thirty (30) rats divided into five groups (A-E) of 6 rats each were used for the study. Groups A, B and C rats received feed supplemented with S. cerevisiae (at 0.08, 0.12 and 0.16/kg of feed, respectively) for the duration of the study. Groups D and E diets were not supplemented. All the rats in the 5 groups were immunized with 0.3 ml of 10% sheep red blood cells (SRBC) at day 7 pre-supplementation, and booster doses given every 14 days thereafter. On day 28 post supplementation (PS), rats of groups A-D were infected with 1 × 10(6) of T. brucei brucei intraperitoneally. Supplementation resulted in increases in antibody titres to SRBC which later declined following T. brucei brucei infection, but remained higher than the pre supplementation titres. At termination of the study (i.e. day 49 PS) supplemented groups had significantly (p<0.05) higher antibody titres than either the infected or the non infected controls. The total and differential leucocyte counts followed a similar pattern with initial increases in counts following supplementation followed by reductions after T. brucei brucei infection. Supplementation also resulted in decline in parasitaemia with significant difference between the supplemented groups and the un-supplemented controls on day 42 post infection. The results are indication that probiotics can be used to ameliorate the immunosuppressive effect of T. brucei brucei infections., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The management of arterial aneurysm either central or peripheral has undergone evolution over the past decades. We encounter both true and pseudo aneurysm on regular basis with its complications:, Objective: To assess the challenges of managing arterial aneurysm at UNTH, Enugu in view of the health complications of the condition., Method: Medical records of all patients with documented arterial aneurysm over a 5-year period (2007-2011) were reviewed. Data collected and documented included patients' demographics, type of vessels involved, investigative tools used in confirming the diagnosis, type of treatment, outcome and length of hospital stay., Result: Atotal of 37 patients were managed for arterial aneurysm during the period under review. These consisted of 24 males (64.9%) and 13 females (35.2%). Age range was 11-78 years with a mean of 2.4 years. Central aneurysms involved ascending, arch and descending aorta as well as abdominal aorta. Peripheral ones affected femoral, axillary, brachial, and popliteal artery. The central aneurysms with the exception of abdominal aortic aneurysms were managed conservatively. Those that failed conservative management were referred to centres with expertise and facilities for on pump surgery. The peripheral ones in addition to abdominal aortic aneurysms were managed operatively with good outcome. The challenges identified in the management included non-availability of on pump expertise and prosthesis, late presentation of patients, under utilisation of CT and or MRI, poor compliance to antihypertensive drugs and poor follow up., Conclusion: Intervention in arterial aneurysms is the gold standard but not yet easily available and affordable at this centre. The challenges that have been identified are real and need to be addressed in order to deliver optimal care to patients within our domain. Efforts are underway in tackiling them.

Aim: This study is designed to identify the associated occupations most at risk of developing lymphoid malignancies., Patients and Methods: The medical records of all lymphoid malignancy cases seen in University of Benin Teaching Hospital between July 2001 and June 2010 were retrieved from medical record library. The patient's bio-data, occupational, social and past medical history and pathologic subtypes were extracted., Results: A total of 252 patients records with diagnosis of lymphoid malignancies were reviewed in this study. Farmers (20.6%) and students (38.9%) form the majority of the cases seen and both showed statistically significant association with risk of LM (p<0.0001), Conclusion: This study revealed that agricultural workers and students in Benin City are at higher risk of developing lymphoid malignancies. Although previous studies have implicated agricultural exposure, the same cannot be said about students. It is therefore recommended that a follow up study should be conducted to ascertain the possible environmental, nutritional, social/lifestyle stressors that put students in Benin City at higher risk of lymphoid malignancies.

Unlabelled: Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity., Method: Case note of a patient managed for traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity was used with a review of relevant literature., Summary: A 49-year old civil engineer who presented with 2-year history of easy fatigability and palpitations as well as a 6-month history of hypertension and was initially managed as a case dilated cardiomyopathy to rule out incipient CCF secondary to hypertension, was evaluated and found to have chronic diaphragmatic hernia through the central tendon with evisceration of the stomach and coils of the small bowel into the pericardial cavity. Though there was history of motor vehicle crash preceding the development of the symptoms, but the long history of effort dyspnoea and palpitations added to enlarged cardiac silhouette on posterior anterior chest x-ray, a diagnostic challenge was posed which was resolved by thoracoabdominal CT scan. Patient had left sided posteriorlateral thoracotomy via 7h intercostal space followed with reduction of thq stomach and coils of small bowel after careful adhesiolysis and repair of the defect in double layers., Conclusion: High index of suspicion is very important in the diagnosis of diaphragmatic central tendon injury considering the rarity of the injury and diagnostic challenges it poses in chronic form. However, where the facilities are available, CT scan and 2-D echo will most of the time clinch the diagnosis; also is upper gastrointestinal series.

Context: Intimate gynaecological examinations are part of the necessary retinue in gynaecological consultation and management., Objective: To evaluate women's perception of digital and speculum vaginal examinations in rural Southeast Nigeria., Methods: This was a prospective descriptive study. Gynaecologic clinic attendees in a Mission hospital in rural Nigeria were interviewed using a pre-tested questionnaire over a 3-year period., Results: Four hundred and eighty-six women with a mean age of 35.2 ± 8.1 years were interviewed. They presented mainly for infertility (36.8%), menstrual abnormalities (31.1%) and early pregnancy complications (10.7%). Over a quarter of the women felt embarrassed at vaginal examination and 37.2% found it a bit painful or felt discomfort. In spite of the discomfort, 73.7% believed vaginal examination was necessary and over 95% indicated readiness to undergo such examination in future if necessary., Conclusion: Performing intimate gynaecological examination should be a carefully planned procedure with patient's consent, and performed conscientiously taking patient's feelings and emotions into consideration, to engender confidence.

Background: The University of Nigeria Teaching Hospital, Enugu was designated the national centre of Excellence for Cardiothoracic diseases, because of the availability of skilled manpower. This study was therefore undertaken to see the pattern of cardiothoracic diseases managed in the surgical unit of the centre and to see if the objectives of its establishment are being achieved., Method: A retrospective analysis of in-patient admission records managed surgically or conservatively between 2000 and 2004 was made., Results: A total of 704 cases were identified; 469 (55.6%) men, 121 (17.2%) women and 114 (16.2%) children. Majority, 163 (23.25%) were between the age range of 20-29 years. Enugu, the State where the hospital is domicile had the highest admission rate of 318 patients (45.15%) while the 19 Northern States had a total of 67 patients (9.51%). Chest wall disorder constituted the majority of cases (28.69%) of which chest trauma from road traffic accident was the majority 49.6%. Most patients were hospitalised for an average of 2-4 weeks (56%)., Conclusion: The study revealed a low admission rate with a declining trend over the years and a skewed distribution of their origin. It also identifies militating factors and draws the attention of the relevant authorities to take necessary actions to stem this trend.

Background: The role of obstetric sonography in the development of diagnostic ultrasound technology has remained invaluable in obstetric and gynaecological investigation., Objectives: This work investigated the awareness of information, expectations and experiences of pregnant women coming for obstetric sonography., Methods: One hundred and ten (110) pregnant women in Anambra State of Nigeria were prospectively studied during prenatal ultrasound scan., Results: The mean age of the studied population was 30.5 +/- 14.5 years. Majority (85%) of the subjects were already aware of obstetric ultrasound scan. Most of the subjects were between the ages of 26-35. 73% got their information from antenatal centre. Over 20% were interested in the lies and presentation of their foetus. During the scan, about 69% subjects interested with the sonographers, and more than half of the population (51%) saw their babies., Conclusion: The role of prenatal a-sonography in obstetric care should be promoted by creating awareness campaign in antenatal centres, and initiating mother/sonographers interaction are necessary.

Background: Ruptured uterus is an obstetric catastrophe and results in significant maternal and perinatal morbidity and mortality in Nigeria., Methods: To review the incidence and management of ruptured uterus over the 8-year period (2000-2004 and 2007-2009) and analysis of records of cases of ruptured uterus during the period under review in a descriptive study., Results: The incidence of uterine rupture is 1 in 81 deliveries with a contribution of 13.8% to maternal mortality in Ebonyi State University Teaching Hospital, Nigeria. There was high fetal wastage as 99 (97.1%) of the babies died. The highest incidence of ruptured uterus was found in the para 2-4 group. Teenagers constituted 4 (3.96%) of the cases. Majority of the rupture, 69 (65.4%) occurred anteriorly. Fifty-seven (56.4%) had only repair of the rupture done. The greatest complication was septicemia, which occurred in 32 (31.7%) of the patients., Conclusion: The incidence of uterine rupture is very high in our center. It is one of the highest causes of maternal and perinatal morbidity and mortality. There should be a multi-pronged effort aimed at improving the utilization of medical services by the populace and the health institutions offering efficient obstetric emergency care.

Background: Early pregnancy losses are a source of deep emotional trauma to any woman, her family and the attttending Gynaecologist. This study evaluated the prelence, pattern and management outcomes of such losses at a tertiary Health Institution., Methods: Data of all women who suffered early pregnancy losses between 1st January, 2002 and 31st December, 2004, were reviewed in a descriptive study. Information obtained from their case notes which related to the early pregnancy event, their socio demographics, obstetric history and management outcomes were collated. Univariate analysis was performed and frequency tables and figures were constructed where appropriate., Results: Early pregnancy losses comprised miscarriages, molar pregnancy and ectopic gestations accounted for 32.1% of all gynaecological admissions during the period. Miscarriages were the commonest diagnosis and incomplete abortion constituted the bulk of this. Women of all parities were involved but rate of loss increased down the socio economic class strata. Majority were unbooked. A maternal mortality rate of 1.8% attended all forms of early pregnancy losses during the period., Conclusion: Early pregnancy loss constitutes a major gynaecological problem in our centre. Health care providers must institute prompt and appropriate clinical management for a good clinical outcome.

Background: Previous studies on aneurysms in Nigeria have either been case reports or studies of peripheral aneurysms. No study has comprehensively evaluated all aspects of this disease as an entity among Nigerians. The need therefore arises to re-evaluate this lesion so as to make deductions on incidence, sex ratio, aetiology and management., Study Design: This is a retrospective descriptive study of arterial aneurysms at the University of Nigeria Teaching Hospital (UNTH), Enugu. Those treated between January 1993 and December 2002 were included for the study. Data were obtained from medical records for all patients admitted with aneurysms over the study period., Results: Atotal of 26 patients were admitted during the period, but 24 case notes were analysed. The age range was 10-75 years with male: female ratio of 1.4:1. Traumatic pseudo aneurysms accounted for 16 cases (67.0%) while true aneurysms comprised the remaining. Of all the aneurysms, femoral artery with most of the pseudo aneurysms had 8 out of 24 (33.0%). This is followed by the infra-renal abdominal aorta (5/24, 21.0%) and other sites (11/24, 46.0%). Diagnoses were made clinically in most cases and by abdominal ultrasonography in abdominal aortic aneurysms. Twenty-one patients had surgical intervention with 9.5% operative mortality., Conclusion: The incidence of aneurysm is low in our locality (2.6/year) based on the rate of diagnosis. Abdominal aorta harbours most of the true aneurysms with diameter ranging from 8.0-15.0 cm without rupture. Untreated, all will eventually rupture with catastrophic consequences. Treatment involved excision with graft interposition. This is not only expensive but the graft is often not readily available. As a solution, grafts should be stocked with drug revolving fund.

Introduction: Uterine rupture is an obstetric catastrophe that is associated with high maternal and perinatal mortality rates. Its incidence is high in developing countries. In Nigeria, the incidence of uterine rupture continues to increase due to poverty, illiteracy, ignorance, the lack of quality obstetric care and bad governance., Methods: A retrospective review was conducted of all cases of ruptured uterus seen at the Mater Misericordiae Hospital in Afikpo, Nigeria between January 2001 and December 2007., Results: There were a total of 51 ruptured uteri out of 4,361 deliveries, yielding a ratio of one in 86. A total of 19 (37.3 percent) patients had a scarred uterus, while 32 (62.7 percent) had an intact uterus, yielding a scarred to unscarred uterus ratio of one in 1.7. The mean maternal age was 32.0 years, and the mean parity was 3.4. Patients with a scarred uterus had a lower mean age and parity. 29 (56.9 percent) cases were unbooked, out of which seven (24.1 percent) had a scarred uterus. Obstructed labour (88.2 percent), grandmultiparity (27.5 percent) and abnormal lie (9.8 percent) were the main causes of rupture. 39 (76.5 percent) patients had their labour managed at home or by traditional birth attendants before presentation. 45 (88.2 percent) patients underwent uterine repair alone, five (9.8 percent) had uterine repair with bilateral tubal ligation and one (two percent) had a hysterectomy. Three maternal deaths occurred, yielding a case fatality rate of 5.9 percent. The perinatal mortality rate was 84.6 percent., Conclusion: Health education, the provision of quality obstetric care, improved governance and monitoring of the activities of traditional birth attendants may help to reduce the menace of uterine rupture.