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Background: One of the late complications of transurethral resection of the prostate (TURP) is urethral stricture. This is a disturbing problem more so in a resource-poor Black African community. We sought to prospectively study some of the implicated risk factors in literature. PATIENTS AND METHODS: This was a prospective, observational study carried out at 82 Division Military Hospital, Enugu, Nigeria from 2015 to 2022. Results: One hundred and ninety-four patients that had TURP for BPH were studied. The mean age of the participants was 66.28 years (standard deviation = 8.19). Ten patients (5.15%) had urethral stricture after the surgery. None of the factors studied which include age, previous prostate surgery, preoperative urethral catheter duration, resection time, resected prostate size, the presence of diabetes mellitus, and postoperative urinary tract infection was found to have a significant risk for the development of urethral stricture post-TURP. Conclusion: More studies are required to unravel significant risk factors for urethral stricture following a TURP. It is probably due to the interplay of many factors.

Aims: The purpose of this study is to determine whether bisacodyl rectal suppository can reduce infective complications postprostate biopsy. Patients, Materials and Methods: This was a comparative cross-sectional study done at the urology unit of a tertiary hospital over 12 months. A sample size of 56 was determined using Fisher's formula. Both groups had tablets of ciprofloxacin 500 mg and metronidazole 400 mg at induction of anaesthesia and continued for three days postbiopsy at a dose of 500 mg twice daily and 400 mg thrice daily, respectively. In addition to antibiotics, those in Group 1 had 20 mg of bisacodyl (Dulcolax) suppositories given at night, starting two days before the procedure. The patients underwent digitally guided 10-core transrectal prostate biopsy on an outpatient basis. Blood and urine samples were taken for full blood count and urine culture, respectively, before surgery and three days after the biopsy. Statistical analysis was performed using the SPSS version 21.0. The level of significance was set at P < 0.05. Results: The mean age was 69.64 ± 9.31 with a range of 52–90 years. The peak age distribution was 70–79. In Group 1, two patients had urosepsis, one patient had urinary tract infection (UTI), and seven patients had bacteriuria, while in Group 2, four patients had urosepsis, four patients had UTI, and ten patients had bacteriuria. Conclusions: The addition of bisacodyl rectal suppository to antibiotics reduced the frequency of infective complications following prostate biopsy. The observed difference, however, was not statistically significant.

Background: Climate change threatens sub-Saharan Africa's agricultural production, causing abiotic and biotic stressors. The study of plant responses to joint stressors is crucial for understanding molecular processes and identifying resilient crops for global food security. This study aimed to explore the shared and tailored responses of okra plants (cv. ''Meya'), at the biochemical and molecular levels, subjected to combined stresses of drought and Meloidogyne incognita infection., Design: The study involved 240 okra plants in a completely randomized design, with six treatments replicated 20 times. Okra plants were adequately irrigated at the end of every 10-days water deficit that lasted for 66 days (D). Also, the plants were infected with M. incognita for 66 days and irrigated at 2-days intervals (R). The stresses were done independently, in sequential combination (D before R and R before D) and concurrently (R and D). All biochemical and antioxidant enzyme assays were carried out following standard procedures., Results: Significant reductions in leaf relative water content were recorded in all stressed plants, especially in leaves of plants under individual drought stress (D) (41.6%) and plants stressed with root-knot nematode infection before drought stress (RBD) (41.4%). Malondialdehyde contents in leaf tissues from plants in D, nematode-only stress (RKN), drought stress before root-knot nematode infection (DBR), RBD, and concurrent drought-nematode stress (RAD) significantly increased by 320.2%, 152.9%, 186.5%, 283.7%, and 109.6%, respectively. Plants in D exhibited the highest superoxide dismutase activities in leaf (147.1% increase) and root (105.8% increase) tissues. Catalase (CAT) activities were significantly increased only in leaves of plants in D (90.8%) and RBD (88.9%), while only roots of plants in D exhibited a substantially higher CAT activity (139.3% increase) in comparison to controlled plants. Okra plants over-expressed NCED3 and under-expressed Me3 genes in leaf tissues. The NCED3 gene was overexpressed in roots from all treatments, while CYP707A3 was under-expressed only in roots of plants in RBD and RKN. CYP707A3 and NCED3 were grouped as closely related genes, while members of the Me3 genes were clustered into a separate group., Conclusion: The biochemical and molecular responses observed in okra plants (cv. ''Meya') subjected to combined stresses of drought and Meloidogyne incognita infection provide valuable insights into enhancing crop resilience under multifaceted stress conditions, particularly relevant for agricultural practices in sub-Saharan Africa facing increasing climatic challenges., (© 2024. The Author(s).)

Introduction: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients' clinical problems more effectively and risk stratify the patient., Method: The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms., Results: There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings., Discussion: Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician's decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bradley, Lee, Albutt, Hardman, Kellar, Odo, Randell, Rousseau, Tikka, Patterson and Paleri.)

Introduction: Between 2009/2010 and 2019/2020, England witnessed an increase in suspected head and neck cancer (sHNC) referrals from 140 to 404 patients per 100 000 population. 1 in 10 patients are not seen within the 2-week target, contributing to patient anxiety. We will develop a pathway for sHNC referrals, based on the Head and Neck Cancer Risk Calculator. The evolution of a patient-reported symptom-based risk stratification system to redesign the sHNC referral pathway (EVEREST-HN) Programme comprises six work packages (WPs). This protocol describes WP1 and WP2. WP1 will obtain an understanding of language to optimise the SYmptom iNput Clinical (SYNC) system patient-reported symptom questionnaire for sHNC referrals and outline requirements for the SYNC system. WP2 will codesign key elements of the SYNC system, including the SYNC Questionnaire, and accompanying behaviour change materials., Methods and Analysis: WP1 will be conducted at three acute National Health Service (NHS) trusts with variation in service delivery models and ensuring a broad mixture of social, economic and cultural backgrounds of participants. Up to 150 patients with sHNC (n=50 per site) and 15 clinicians (n=5 per site) will be recruited. WP1 will use qualitative methods including interviews, observation and recordings of consultations. Rapid qualitative analysis and inductive thematic analysis will be used to analyse the data. WP2 will recruit lay patient representatives to participate in online focus groups (n=8 per focus group), think-aloud technique and experience-based codesign and will be analysed using qualitative and quantitative approaches., Ethics and Dissemination: The committee for clinical research at The Royal Marsden, a research ethics committee and the Health Research Authority approved this protocol. All participants will give informed consent. Ethical issues of working with patients on an urgent cancer diagnostic pathway have been considered. Findings will be disseminated via journal publications, conference presentations and public engagement activities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Urological surgeries are a significant part of surgical services. The need for these services varies regionally and globally. Knowledge of the local need is important for prioritisation of resources., Objectives: To describe the urological procedures done in our hospital for effective utilisation of the already scarce resource in this region., Patients and Methods: This was a retrospective one-year study of the urosurgical cases done in a Nigerian Teaching Hospital. The main theatre register was used to collate data. Data collected included age, sex, operation done and anaesthesia employed., Results: One hundred and twenty-two male and three female patients were included with a male-to-female ratio of 41:1. The mean age of the patients was 56.6 ± 19.89 years. Elective cases accounted for 102 (81.6%) of surgeries. Regional anaesthesia was the most common form of anaesthesia accounting for 105 (84%) followed by local anaesthesia in 16 (12.8%). Day cases accounted for 77 (61.6%) of procedures. More than 80% of the study population was 50 years and older. Overall, the three most common performed surgeries were digital-guided prostate biopsy 47 (37.6%), suprapubic cystostomy 16 (12.8%) and open prostatectomy 9 (7.2%). In male patients, the three most common procedures were prostate biopsy 47 (38.5%), suprapubic cystostomy 16 (13.1 %), open prostatectomy 9 (7.4%) whereas nephrectomy, pyeloplasty and stent removal each accounted for 33.3% each of procedures in female patients. Endourological procedures accounted for 5 (4%) of cases., Conclusion: Open surgeries accounted for the majority of these cases done with prostate-related procedures being the most common procedures. Few endourological procedures were performed., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of the west African college of surgeons.)

The family is the simplest unit but possesses the strongest bond in society. These qualities - bond and proximity - that exist both within and across neighboring families, according to our research, can be instrumental in shaping a new kind of health promotion strategy that can transform health behaviors in communities. The Whole Family Approach (WFA) is a government-sanctioned approach to increase uptake of COVID-19 vaccines in Nigeria. The approach entails leveraging the high family-based demand for some primary health services, such as malaria, diabetes, hypertension, and reproductive services, to generate demand for COVID-19 and routine immunizations. However, since the announcement in 2021, there has been no available evidence to show the impact of the approach on COVID-19 vaccine uptake, though global literature generally favors family-centered health approaches. This study tests the effectiveness of the approach in increasing the utilization of target services in a Nigerian community and further provides a theoretical framework for the strategy. Two primary healthcare facilities were selected in two communities located in Abuja in a quasi-experimental design. After a small-sample landscape assessment of the communities and the facilities, family-targeting health promotion activities were facilitated in the intervention community (integrated health education by trained community health influencers) and facility (opportunistic health promotion through in-facility referrals) for one month. Anonymized service utilization data were acquired from both facilities over a period of four months to analyze their respective month-by-month service utilization trends. Time trend analysis was conducted and revealed that WFA significantly increased service utilization ( N  = 5870; p  < 0.001, α  = 0.01, 99% CI) across all the package services provided at the intervention facility. A supplementary Pearson's correlation analysis further presented a positive relationship ( r  = 0.432-0.996) among the services which favored the result. It can therefore be concluded that the "Whole Family Approach" of health promotion is efficacious in accelerating uptake of priority health services such as COVID-19 and routine immunizations. While there is more to be understood about this interesting approach, we recommend the improvement of communication and capacity gaps in Nigeria's primary healthcare system to ensure that promising strategies such as the WFA are adequately implemented at the community and facility levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Ade-Banjo, Offor, Nwankwo, Nwaononiwu, Adukwu, Egharevba, Owoyemi, Odo and Olatunji.)

Background: To demonstrate the outcome of our initial experience in the management of upper tract stones with ureteroscopy and Holmium: YAG laser lithotripsy., Methodology: The data of thirty-two patients who had ureteroscopy and laser lithotripsy for upper urinary tract stones at a private urology centre in Awka, Anambra State Nigeria from September 2020 to June 2022 (20months) were retrospectively studied. Their sociodemographic data, clinical symptoms, the location and size of the stones, preoperative and postoperative stent use, hospital stay, complications, and stone-clearance rates were analyzed., Results: A total of 32 procedures were performed on 32 patients. The mean age of the patients was 44.7 ± 12.2 years. The mean stone size was 15.4 ± 6.7mm with a range of 8.0-39mm, and Hounsfield unit ranging from 233-906. The stones were on the right tract, left tract, and bilateral in 46.9%, 43.7%, and 9.4% of the cases respectively. The patients had a mean length of hospital stay of 3.31 ± 1.45 days. The stone clearance rate was 90.3%. 53.1% of the patients had postoperative complications with 40.6% of these being post-operative fever which resolved with antibiotics. There was treatment failure in one patient due to the inability to scope the ureter on account of ureteral stricture., Conclusion: Ureteroscopy and laser lithotripsy are safe and effective options in the management of upper tract stones with the advantages of being performed via a natural orifice, being less painful, with reduced risk of severe bleeding, irreversible loss of renal parenchyma, as well as a short hospital stay., (Copyright © 2023 Nigerian Medical Association.)

In recent decades, cardiovascular disease (CVD) has become the leading cause of death in most countries of the world. Since many types of CVD are preventable by modifying lifestyle behaviors, the objective of this paper is to develop an effective personalized lifestyle recommendation algorithm for reducing the risk of common types of CVD. However, in practice, the underlying relationships between the risk factors (e.g., lifestyles, blood pressure, etc.) and disease onset is highly complex. It is also challenging to identify effective modification recommendations for different individuals due to individual's effort-benefits consideration and uncertainties in disease progression. Therefore, to address these challenges, this study developed a novel data-driven approach for personalized lifestyle behaviors recommendation based on machine learning and a personalized exponential utility function model. The contributions of this work can be summarized into three aspects: (1) a classification-based prediction model is implemented to predict the CVD risk based on the condition of risk factors; (2) the generative adversarial network (GAN) is incorporated to learn the underlying relationship between risk factors, as well as quantify the uncertainty of disease progression under lifestyle modifications; and (3) a novel personalized exponential utility function model is proposed to evaluate the modifications' utilities with respect to CVD risk reduction, individual's effort-benefits consideration, and disease progression uncertainty, as well as identify the optimal modification for each individual. The effectiveness of the proposed method is validated through an open-access CVD dataset. The results demonstrate that the personalized lifestyle modification recommended by the proposed methodology has the potential to effectively reduce the CVD risk. Thus, it is promising to be further applied to real-world cases for CVD prevention., 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 Inc. All rights reserved.)

Background: Physical inactivity (PIA) is the fourth leading risk factor in an estimated global death of 3.2 million annually. To reverse this negative impact of PIA, there is a need to increase physical activity (PA). This could be achieved through creation of awareness, promotion, and good practice of PA by healthcare workers., Objective: To evaluate physical activity among healthcare workers (HCW) in a major tertiary hospital, southeast Nigeria., Methods: The Global Physical Activity Questionnaire (GPAQ) was researcher-administered to investigate PA level among consenting HCW who met the inclusion criteria. Participants were recruited from their workstations in the hospital. The questionnaire recorded age, anthropometrics, demographics, and physical activity. Data were summarized with descriptive statistics of frequency and percentages. The spearman rank correlation test was used to assess for the relationship between PA and socio-demographic factors., Results: There were 209 participants with 93 (44.5%) males and 116 (55.5%) females. The mean age was 34.32±9.88 years. Amongst different professions, Nurses were 53(25.3%), Doctors, 31 (14.8%), and Dietitians, 21 (10%), Accountants, 19 (9.1%). The majority of the participants 100 (47.8%) had physical activity level that was high (extra sufficient), 31 (14.8%) had a moderate PA level while 78 (37.3%) had a low physical activity level. There was a significant negative relationship between PA and age, marital status, number of children, and other dependents respectively, whereas there was no significant relationship between PA and gender, income, and family type., Conclusion: HCWs have the minimum required PA in a week. About 63% met the minimum required PA in a week. Age, marital status, and having children or dependents reduce participation in PA. However, there is a need for conscious awareness and practice of PA among HCW in the hospital., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Background: Hepatitis B and C viruses and HIV infections contribute a significant proportion to maternal and perinatal morbidity and mortality in low and middle-income countries. While the burden of hepatitis B and C viruses is higher in low and middle-income countries, Nigeria also has the second largest burden of HIV., Objectives: To determine the seroprevalence of hepatitis B and C viruses and HIV infections among antenatal women who sought care at a secondary health facility in Lagos., Methods: This was a retrospective review of patients managed in the antenatal clinic of 68 Nigerian Army Reference Hospital over one year. A study proforma was used to collect relevant data which were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23., Results: A total of 347 women attended prenatal care during the study period, however, only 329 cases with complete data were included in the final statistical analysis. The prevalence of HIV in our study was 6.4%, while HBV and HCV accounted for 6.2% and 1.8% respectively. Hepatitis B, and hepatitis C viruses and HIV Infections occurred in 3 (0.9%) of our patients, 6 (1.8%) of the women had HIV-HBV co-infection while 1 (0.3%) was infected with HIV-HCV., Conclusion: Our study re-emphasizes the public health importance of HBV, HCV and HIV screening in our antenatal clinics. This knowledge is very important for the implementation of effective prevention and control measures that will further decrease the mother-to-child transmission of these viruses., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Introduction: Prostate cancer (CaP) is the second most common cancer in men and the fifth most common cancer worldwide. The incidence in Nigeria is rising. Numerous challenges exist that prevent the successful management of these patients in this subregion., Aims and Objectives: This study aimed to report on the modes of presentation and difficulties encountered in managing patients with CaP in our environment with a view to finding solutions to these challenges., Materials and Methods: This was a retrospective study of all CaP patients who were managed in Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria over a 10-year period from 2012 to 2021. Data were collated using a pro forma. Numerical data were summarized as means, median, and standard deviation, whereas categorical data were summarized as frequencies. Statistical significance was pegged at P < 0.05., Results: Seventy-three patients were analysed. The mean age of the patients was 71.48 ± 8.15 years. The three most common presenting complaints were lower urinary tract symptoms (LUTSs) 23 (31.5%), acute urinary retention 9 (12.3%), and LUTS with low back pain 9 (12.3%). The median duration of symptoms was 6.5 months. No difference was noted among educational level, occupation, and stage of CaP, ( P =0.222 and P =0.548), respectively. The median total prostate-specific antigen was 85.0 ng/mL. Sixty-seven patients (91.8%) had an abdominopelvic ultrasound scan. Fifty patients (68.5%) had stage 4 disease. Thirty-eight (52.1%) had financial constraints. Forty-nine (67.1%) patients were lost to follow-up. Bilateral orchidectomy was offered to 28 (38.4%) patients., Conclusion: Financial constraint was a huge barrier in the management of CaP patients in this study. Late presentation was common in this study., Competing Interests: Nil., (Copyright: © 2022 Journal of the West African College of Surgeons.)

Critical, time-bounded, and high-stress tasks, like incident response, have often been solved by teams that are cohesive, adaptable, and prepared. Although a fair share of the literature has explored the effect of personality on various other types of teams and tasks, little is known about how it contributes to teamwork when teams of strangers have to cooperate ad-hoc , fast, and efficiently. This study explores the dynamics between 120 crowd participants paired into 60 virtual dyads and their collaboration outcome during the execution of a high-pressure, time-bound task. Results show that the personality trait of Openness to experience may impact team performance with teams with higher minimum levels of Openness more likely to defuse the bomb on time. An analysis of communication patterns suggests that winners made more use of action and response statements. The team role was linked to the individual's preference of certain communication patterns and related to their perception of the collaboration quality. Highly agreeable individuals seemed to cope better with losing, and individuals in teams heterogeneous in Conscientiousness seemed to feel better about collaboration quality. Our results also suggest there may be some impact of gender on performance. As this study was exploratory in nature, follow-on studies are needed to confirm these results. We discuss how these findings can help the development of AI systems to aid the formation and support of crowdsourced remote emergency teams., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Vinella, Odo, Lykourentzou and Masthoff.)

Background: Clostridioides difficile infection (CDI) is a leading cause of hospital-associated antibiotic-related diarrhea and deaths worldwide. Vancomycin is one of the few antibiotics recommended for both nonsevere and severe CDI cases. We sought to determine whether vancomycin nonsusceptible C. difficile strains are circulating in the patient population., Methods: Stool samples from patients with CDI were collected from 438 and 98 patients at a large university hospital in Houston, Texas, and Nairobi, Kenya, respectively. The stools were examined for the presence of vancomycin and metronidazole nonsusceptible C. difficile using broth dilution culture, Etest (BioMérieux, France), polymerase chain reaction (PCR), whole-genome sequencing, and in vivo testing in a CDI mouse model., Results: Of the Houston stool samples, 114/438 (26%) had vancomycin nonsusceptible C. difficile isolates and 128/438 (29%) were metronidazole nonsusceptible. Similarly, 66 out of 98 (67%) and 83/98 (85%) of the Nairobi patients harbored vancomycin and metronidazole nonsusceptible isolates, respectively. Vancomycin treatment of a CDI mouse model infected with a vancomycin nonsusceptible isolate failed to eradicate the infection. Whole-genome sequencing analyses did not identify vanA genes, suggesting a different mechanism of resistance., Conclusions: C. difficile strains exhibiting reduced susceptibility to vancomycin are currently circulating in patient populations. The spread of strains resistance to vancomycin, a first-line antibiotic for CDI, poses a serious therapeutic challenge. Routine susceptibility testing may be necessary., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)