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National Health Insurance (NHI) was originally a health financing reform that eventually became a ‘driver’ for changes in all health care sectors. The burden on doctors in health facilities is likely to increase due to its changes in standard fees for medical services. This study aimed to describe NHI system changes that will affect doctor’s professionalism. This is a systematic review taken from MEDLINE complete of EBSCOhost research database. The search period range covered between 1983 to October 19 2018. The results revealed 853 unique citations which globally stated about the potential impact of NHI implementation on doctors. The majority studies indicate that there is a relationship of the implementation of NHI, workload of doctors and quality of health care service. It can be concluded that NHI implementation requires a large quantity of human resources, especially doctors. Therefore, doctors are advised to adapt to their role and function in this era of NHI.

Entomopathogenic fungi produces endochitianses, involved in the degradation of insect chitin to facilitate the infection process. Endochitinases (Chit1) gene of family 18 glycosyl hydrolyses were amplified, cloned and characterized from genomic DNA of two isolates of Metarhizium anisopliae. Catalytic motif of family 18 glycosyl hydrolyses was found in Chit1 of M. anisopliae, while no signal peptide was found in any isolate, whereas substrate-binding motif was found in Chit1 of both isolates. Phylogenetic analysis revealed the evolutionary relationship among the fungal chitinases of Metarhizium. The Chit1 amplified were closely related to the family 18 glycosyl hydrolyses. Transient expressions of Chit1 in cotton plants using Geminivirus-mediated gene silencing vector of Cotton Leaf Crumple Virus (CLCrV) revealed the chitinase activity of Chit1 genes amplified from both of the isolates of M. anisopliae when compared with the control. Transformed cotton plants were virulent against fourth instar nymphal and adult stages of Bemisia tabaci which resulted in the mortality of both fourth instar nymphal and adult B. tabaci. Thus, the fungal chitinases expressed in cotton plants played a vital role in plant defence against B. tabaci. However, further studies are required to explore the comparative effectiveness of chitinases from different fungal strains against economically important insect pests.

Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the pleura but are now being reported in other anatomic sites as well. SFT is generally characterised as a radiologically confined neoplasm composed of a proliferated spindle cells arranged in patternless manner. Intervening tissue shows prominent haemangiopericytoma-like vessels. Stroma is usually fibrous. Tumour is positive for CD34. SFT has a specific translocation representing fusion NAB2 with STAT6 genes. This translocation can be highlighted with very good specificity and sensitivity using STAT6 immunohistochemical stain. Some cases of SFTs have also been described in the breast. Rarely, SFT can show aggressive behaviour. SFT enters the differential diagnoses of benign and malignant spindle cell tumours of breast and it is, therefore, important that its clinical, radiological and pathological features are known to clinicians and diagnosticians. Key words: CD34, myofibroblastoma, NAB2-STAT6, solitary fibrous tumour

This study assessed the factors influencing participation of cassava farmers in Survival Farming Intervention Programme (SFIP) in Agricultural Zone C of Kogi State. A multi-stage sampling technique was used to select 180 respondents comprising of cassava grower in the study area. Primary data were collected with the aid of questionnaires complemented with interview schedule. Both descriptive and inferential statistics were used to analyze the data collected. The results of the analysis revealed that the majority (72.8%) of the respondents were within the age range of 36 - 55 years while 94.5% the respondents were married with just few divorced and widowed. Similarly, 30.0% of the respondents had no formal education while 28.9%, 35.6% and 3.9% attained primary, secondary and tertiary education respectively. Logistic regression analysis showed coefficient of determination, R2 of 0.67969 meaning that about 68% of the variation in the participation in SFIP were explained by the independent variables in the model. Age, labour, education, household size, awareness, extension contact and planting material were significant at 1% level of probability while marital status was significant at 5% level of probability. They all had positive coefficients and direct relationship with participation in SFIP implying that one unit increase in any of the variable coefficients will result to an increase in level of participation. Participation in SFIP was statistically influenced by socio-economic factors such as age, education, household size and others in the study area. Therefore, provisions of basic amenities that will improve the socio-economic status of the cassava farmers are highly recommended through government and non-governmental organisations. Keywords: intervention, programme, participation.

Latar belakang. Resistensi antibiotik saat ini menjadi problem dunia yang mencemaskan. Penggunaan antibotik secara berlebihan dan tidak rasional merupakan kontributor utama terjadinya resistensi antibiotik. Upaya mengubah pola peresepan antibiotik menjadi lebih rasional merupakan hal yang tidak mudah. Tujuan. Memperbaiki kuantitas dan kualitas penggunaan antibiotik pada pasien yang dirawat dengan demam, serta mengevaluasi dampak terhadap morbiditas dan mortalitas. Metoda. Penelitian prospektif intervensi di bangsal anak RS Dr Kariadi, Juli 2003 - Desember 2004, dibagi menjadi 4 periode yaitu periode awal, penyusunan pedoman, pelatihan, dan umpan balik. Pada periode awal dilakukan pengambilan data dasar. Pada periode penyusunan pedoman dilakukan konsensus untuk menyusun pedoman penggunaan antibiotik pada anak dengan demam. Periode pelatihan adalah sosialisasi dan pelatihan kepada dokter. Pada periode pascapelatihan dilakukan umpan balik terhadap peserta pelatihan. Subyek penelitian adalah semua pasien usia >1 bulan yang dirawat dengan demam> 38ºC (rektal) dalam 24 jam pertama perawatan, kecuali yang diketahui menderita HIV/AIDS atau neutropeni karena kemoterapi. Data penggunaan antibiotik diambil dari catatan medik, diamati selama 6 hari pertama perawatan. Data morbiditas dan mortalitas diamati sampai pasien keluar dari rumah sakit. Uji statistik menggunakan X 2 dan Anova. Hasil. Terdapat penurunan kuantitas penggunaan antibiotik dan peningkatan kualitas penggunaan antibiotik secara bermakna (p=0.000 dan p=0,000). Penurunan kuantitas antibiotiok terutama disebabkan pengurangan penggunaan antibiotik yang tidak diperlukan. Tidak terdapat perbedaan lama rawat dan lama demam (p=0.96 dan p=0.32) dan tidak terdapat perbedaan kematian selama periode pengamatan. Kesimpulan. Dengan pedoman yang baik, penggunaan jumlah antibiotik dapat diturunkan tanpa meningkatkan risiko morbiditas dan mortalitas.

In this paper, we present a novel ?Make-Before-Break? routing protocol for VANETs (Vehicular Ad Hoc Networks) which brings stability in route even if it contains some nodes moving opposite to the rest. Few of the existing routing protocols contain the mechanism to prevent route disruption caused by link breakages between oppositely moving nodes in a partitioned network. In our protocol, a node does not forward a RREQ (Route Request) received from a node moving in opposite direction unless a special request is made by that node in RREQ packet. The node which accepts this special request and forwards the RREQ, despite moving opposite to the previous node is called complier node. The complier node adds its information in the RREQ packet. On receiving RREQ, the destination knows that complier node is moving towards some successive nodes in the routing path. Through the RREP (Route Reply), it informs those nodes about the complier node. Each of these successive nodes waits for the approaching complier node. When it comes near, each establishes connection with the complier node on its turn. Thus the route from source to destination is maintained. The proposed protocol achieves packet delivery ratio of 85% under very large speed variation condition among vehicles? speed.

The purpose of this research is to separate different morphological particles of ASTM class F fly ash, and study their effect on mechanical behaviour and durability of high volume cementitious mixtures. In this research wet separation of raw fly ash is carried out, which resulted in three layers of different morphological particles. The first layer of particles float, comprise of about 1-5% of fly ash, is identified as cenospheres or hollow spheres. The second layer of particles is measured to be 55-60% of raw fly ash and consisting of porous spherical and rounded particles rich in Si and Al. The third layer particles is measured to be about 35-40% of raw fly ash. High volume fly ash cementitious composites containing second or third layer particles are tested under compression and bending, highlighting a higher strength and ductility in comparison to cementitious ones containing raw fly ash particles

The properties of fly ashes vary because of the differences in the properties of their individual particles, and the determination of variation in these properties is of interest to the industries which use pulverized raw fly ash in applications, such as in cementitious materials and in the recovery of certain rare elements from raw fly ash. To investigate the differences in individual particles, four pulverized raw fly ashes from thermal power plants of the Czech Republic were used in this research. It was observed from FE-SEM that all four fly ashes consist of glassy hollow spherical, solid spherical, porous spherical, bright spherical, porous slaggy and compact slaggy particles. Box and whisker diagrams were plotted from the data of EDX individual particle analyses, which showed that the data of percentages for the Si, Al, and Fe elements is more scattered as compared to other elements. It was further observed from ternary phase diagrams and pseudo coloured images, that nature of fly ash particles changes from alumino silicate glassy to alumino silicate calcite metallic to pure ferro-metallic,where glassy particles showed high percentages and pure calcite particles were absent in fly ashes. Furthermore, a comparison between the XRF, the EDX total area analyses, showed that the EDX individual particle analysis gives more realistic and reliable data with median, mean, and the standard deviation for percentages of each element present in the fly ashes.

Sepsis and septic shock is one of the highest causes of death in patients treated in hospitals. Research Objectives: to evaluate the quality of the management of sepsis patients in Intermediate Care Unit, Department of Internal Medicine Dr. Soetomo Hospital Surabaya, Indonesia. This study was a retrospective study to re-evaluate the patient medical record. The number of patients treated: 275 patients, sepsis patients: 80 patients, the number of patients who entered the study 50 patients, 30 (60%) female and 20 (40%) men, most age groups aged 60 -70 years (32%), Mean 54 Median 56. Diagnostic accuracy according to the criteria of sepsis 45 (90%) patients, compliance with taking blood culture 2 (4%) patients, appropriate antibiotic selection 49 (98%) patients, the number of patients who should not be given antibiotics (4 patients), but given the antibiotic is 3 (75%) patients, the number of patients who should be given antibiotics (46 patients) but were not given antibiotics 1 (2%) patient. The reason of patients discharged: 27 had died (54%), 13 cured (26%), not yet recovered 10 (20%). The reason of patients discharged forcibly: to feel recovered 2 (20%), the condition gets worse 3 (30%), no cost 2 (20%), not clear 3 (30%). Patients with sepsis remain a big problem, and it still needs to improve the management of sepsis on existing guidelines.

In today’s world, security is the most prominent aspect which has been given higher priority. Despite the rapid growth and usage of digital devices, lucrative measurement of crimes in under-developing countries is still challenging. In this work, unstructural crime data (900 records) from the news archives of the previous eight years were extracted to predict the behavior of criminals’ networks and transform it into useful information using natural language processing (NLP). To estimate the next move of criminals in Pakistan, we performed hotspot-based spatial analysis. Later, this information is fed to two different classifiers for possible identification and prediction. We achieved the maximum accuracy of 92% using K-Nearest Neighbor (KNN) and 62% using the Random Forest algorithm. In terms of crimes, the results showed that the most prevalent crime events are robberies. Thus, the usage of digital information archives, spatial analysis, and machine learning techniques can open new ways of handling a peaceful and sustainable society in eradicating crimes for countries having paucity of financial resources.

High capacity long haul communication and cost-effective solutions for low loss transmission are the major advantages of optical fibers, which makes them a promising solution to be used for backhaul network transportation. A distortion-tolerant 100 Gbps framework that consists of long haul and high capacity transport based wavelength division multiplexed (WDM) system is investigated in this paper, with an analysis on different design parameters to mitigate the amplified spontaneous emission (ASE) noise and nonlinear effects due to the fiber transmission. The performance degradation in the presence of non-linear effects is evaluated and a digital signal processing (DSP) assisted receiver is proposed in order to achieve bit error rate (BER) of 1.56 × 10−6 and quality factor (Q-factor) of 5, using 25 and 50 GHz channel spacing with 90 μm2 effective area of the optical fiber. Analytical calculations of the proposed WDM system are presented and the simulation results verify the effectiveness of the proposed approach in order to mitigate non-linear effects for up to 300 km length of optical fiber transmission.

Intelligent Transport Systems (ITS) are anticipated to be one of the key technologies for the next decade and their deployment can benefit from the recent developments in the domain of Visible Light Communication (VLC). Light Emitting Diode (LED)-based low-cost VLC is considered in this work to provide a practical approach towards the implementation of an ITS by addressing the major issues of channel noise, free-space optical multipath reflections and interference from light sources. An analytical model is presented for the proposed Multiple-Input–Single-Output (MISO)-based VLC, and simulations are performed to analyze the performance of the system for various transmission distances. Results show that the proposed optimal receiver for 4 × 1 MISO can provide considerable improvement in the bit error rate for the forward error correction (FEC) threshold of 3.8 × 10−3 in the presence of optical interference, and is suitable to support an ITS with an inter-vehicle transmission approach. The comparison of achieved performance with existing solutions for VLC-based ITS depicts that the proposed framework provides much higher data rates, three times longer transmission distance and improved receiver sensitivity.

Land degradation caused by soil erosion is considered among the most severe problems of the 21stcentury. It poses serious threats to soil fertility, food availability, human health, and the world ecosystem. The purpose of the study is to make a quantitative mapping of soil loss in the Chitral district, Pakistan. For the estimation of soil loss in the study area, the Revised Universal Soil Loss Equation (RUSLE) model was used in combination with Remote Sensing (RS) and Geographic Information System (GIS). Topographical features of the study area show that the area is more vulnerable to soil loss, having the highest average annual soil loss of 78 ton/ha/year. Maps generated in the study show that the area has the highest sediment yield of 258 tons/ha/year and higher average annual soil loss of 450 tons/ha/year. The very high severity class represents 8%, 16% under high, 21% under moderate, 12% under low, and 13% under very low soil loss in the Chitral district. The above study is helpful to researchers and planners for better planning to control the loss of soil in the high severity zones. Plantation of trees and structures should be built like check dams, which effectively control the soil erosion process.

We present a workflow for data sanitation and analysis of operation data with the goal of increasing energy efficiency and reliability in the operation of building-related energy systems. The workflow makes use of machine learning algorithms and innovative visualizations. The environment, in which monitoring data for energy systems are created, requires low configuration effort for data analysis. Therefore the focus lies on methods that operate automatically and require little or no configuration. As a result a generic workflow is created that is applicable to various energy-related time series data; it starts with data accessibility, followed by automated detection of duty cycles where applicable. The detection of outliers in the data and the sanitation of gaps ensure that the data quality is sufficient for an analysis by domain experts, in our case the analysis of system energy efficiency. To prove the feasibility of the approach, the sanitation and analysis workflow is implemented and applied to the recorded data of a solar driven adsorption chiller.

Background: Based on the results Antimicrobial Resistance in Indonesia: prevalence and prevention-study (AMRIN-study), the Ministry of Health of Indonesia in 2005 began a program antibiotic resistance control (PPRA) in some government hospitals, and is currently developing to all government teaching hospitals in Indonesia. Aim: The core activities of the PPRA are to implement standardized surveillance emergence of antibiotic resistant bacteria, and the surveillance of antibiotic use in terms of quantity and quality. Method: Our research in the years 2003 showed the proportion of antibiotic use 84% of patients in a hospital. The use of inappropriate antibiotics was very high, 42% no indication. Result: In 2012 the results of surveillance showed decline of inappropriate use of antibiotic, but prevalence extended-spectrum b-lactamase (ESBL)-producing K.pneumoniae (58%), and E.coli (52%) and methicillin-resistant S.aures (MRSA) (24%) were increasing. Conclusion: It was needed to implement the most appropriate programs to prevent the growth and development of bacteria resistant to antibiotics.

Background and Aim: The basic aim of this study was to find out the association of genotypes with host age, gender and viral load. Material and Methods: The present study was conducted at Social Security Hospital, Pakistan. This study included 320 patients with chronic hepatitis C virus (HCV) infection who were referred to the hospital between November 2011 and July 2012. HCV viral detection and genotyping was performed and the association was seen between genotypes and host age, gender and viral load. Results : The analysis revealed the presence of genotypes 1 and 3 with further subtypes 1a, 1b, 3a, 3b and mixed genotypes 1b + 3a, 1b + 3b and 3a + 3b. Viral load quantification was carried out in all 151 HCV ribonucleic acid (RNA) positive patients. The genotype 3a was observed in 124 (82.12%) patients, 3b was found in 21 (13.91%), 1a was seen in 2 (1.32%), 1b in 1 (0.66%), mixed infection with 1b + 3a in 1 (0.66%), 1b + 3b in 1 (0.66%) and 3a + 3b was also found in 1 (0.66%) patient. Viral load quantification was carried out in all 151 HCV RNA positive patients and was compared between the various genotypes. The mean viral load in patients infected with genotype 1a was 2.75 × 10 6 , 1b 3.9 × 10 6 , 3a 2.65 × 10 6 , 3b 2.51 × 10 6 , 1b + 3a 3.4 × 106, 1b + 3b 2.7 × 106 and 3a + 3b 3.5 × 10 6 . An association between different types of genotypes and viral load was observed. Conclusion : Further studies should be carried out to determine the association of viral load with different genotypes so that sufficient data is available and can be used to determine the type and duration of therapy needed and predict disease outcome.

The world is ageing and this poses a challenge to produce cost-effective solutions that can keep elderly people independent and active by assisting them in daily living activities. In this regard, this paper presents a new control method to provide physical assistance for any of the user joints (e.g., hip, knee, elbow, etc.) as needed by the wearer, by means of an assistive non-medical single joint exoskeleton with a “harmonized controller” capable of providing assistance in a natural way, and varying the assistance as needed by the user performing some activity. The control method is aimed at exoskeletons to provide assistance to users facing difficulty in any activity such as walking, sit-to-stand, etc., and, other than providing assistance as needed, it can also reduce the muscular effort for a completely healthy user. Harmonized control uses exoskeleton-integrated force sensors and motion sensors to identify the user's intentions and the assistance level required, generating appropriate control signals for the actuators by implementing a simple PID controller. To verify the proposed harmonized-control technique, simulations using MATLAB/SIMULINK were performed for a single joint system. An experimental test rig for a single joint was also developed using MATLAB Xpc Target for real-time control. User tests were also carried out for the knee joint and the results obtained from simulations, experimentation and user tests are reported and discussed here. The results achieved to date and reported here show harmonized control to be a promising user-centric solution for the development of single joint assistive exoskeletons for support as needed by the user in daily living activities.

Background: Computed tomography (CT) imaging has improved the chances of detecting small indeterminate (1.5 cm). Results: CT scan reports of 89 patients with lung nodules were reviewed. On radiology, 73/89 (82%) were reported to be malignant nodule. Histopathological review of the biopsies of these 89 nodules confirmed malignancy in 50/89 (56.2%) patients. CT scan was found to be highly sensitive (94%, 95% confidence interval [CI]: 83.43–98.68%) but with a very low specificity (33.3%, 95% CI: 19.10–50.22%). CT scan was found to have a higher negative predictive value (81.2%, 95% CI: 54.34–95.73%) and a lower positive predictive value 64.4% (95% CI: 52.31–75.25%) when correlated with histopathological findings. Pathology of these nodules included metastatic sarcoma (27/89; 30.3%) and carcinoma (18/89; 20.2%). The frequency of the biopsy-proven malignant nodules on the right side was 26/45 (57.8%) and on the left side was 24/44 (54.5%) (P = 0.832). Malignant nodules were more frequent in lower lobes (28/43, 65.1%) than in upper lobes (14/32, 43.8%). These two sites combined accounted for 84% of all malignant nodules. There was a significant correlation between nodule size and likelihood of underlying malignancy. The overall prevalence of malignancy in the larger nodules (C and D) was much higher (23/30 and 76.7%) compared to the smaller sized (A and B) nodules (27/58 and 46.8%), P < 0.05. Conclusion: CT scan is a useful tool in the initial clinical assessment of indeterminate lung nodules with high sensitivity (94%) and a high negative predictive value (81.2%). Key words: Computed tomography, fibrosis, indeterminate lung nodule, infection, lung nodule, malignancy, metastases

In a recent, population-based survey of 3,996 persons in Indonesia, fluoroquinolone (FQ)-resistant Escherichia coli was prevalent in the fecal flora of 6% of patients at hospital admission and 23% of patients at discharge, but not among healthy relatives or patients visiting primary healthcare centers (2%). Molecular typing showed extensive genetic diversity with only limited clonality among isolates. This finding suggests that independent selection of resistant mutants occurs frequently. FQ-resistant isolates exhibited a higher rate of spontaneous mutation, but sparser virulence profiles, than FQ-susceptible isolates from the same population. The resistant isolates belonged predominantly to phylogenetic groups A (57%) and B1 (22%) but also to the moderately virulent group D (20%). Hypervirulent strains from the B2 cluster were underrepresented (1%). Because FQ-resistant E. coli can cause disease, especially nosocomial infections in immunocompromised patients, spread of such strains must be stopped.

Cotton leaf curl virus disease (CLCuD) is caused by a suite of whitefly-transmitted begomovirus species and strains, resulting in extensive losses annually in India and Pakistan. RNA-interference (RNAi) is a proven technology used for knockdown of gene expression in higher organisms and viruses. In this study, a small interfering RNA (siRNA) construct was designed to target the AC1 gene of Cotton leaf curl Kokhran virus-Burewala (CLCuKoV-Bu) and the βC1 gene and satellite conserved region of the Cotton leaf curl Multan betasatellite (CLCuMB). The AC1 gene and CLCuMB coding and non-coding regions function in replication initiation and suppression of the plant host defense pathway, respectively. The construct, Vβ, was transformed into cotton plants using the Agrobacterium-mediated embryo shoot apex cut method. Results from fluorescence in situ hybridization and karyotyping assays indicated that six of the 11 T1 plants harbored a single copy of the Vβ transgene. Transgenic cotton plants and non-transgenic (susceptible) test plants included as the positive control were challenge-inoculated using the viruliferous whitefly vector to transmit the CLCuKoV-Bu/CLCuMB complex. Among the test plants, plant Vβ-6 was asymptomatic, had the lowest amount of detectable virus, and harbored a single copy of the transgene on chromosome six. Absence of characteristic leaf curl symptom development in transgenic Vβ-6 cotton plants, and significantly reduced begomoviral-betasatellite accumulation based on real-time polymerase chain reaction, indicated the successful knockdown of CLCuKoV-Bu and CLCuMB expression, resulting in leaf curl resistant plants.

Purpose: An-organic bovine bone graft is a xenograft with the potential of bone formation. The aim of this study was to evaluate the bone density using cone beam computed tomography scans around functional endosseous implant in the region of both augmented maxillary sinus with the an-organic bovine bone graft and the alveolar bone over which the graft was placed to provide space for the implants. Materials and Methods: Sterile freeze dried bovine bone graft produced by National Tissue Bank, University Sains, Malaysia was used for stage-1 implant placement with maxillary sinus augmentation in a total of 19 subjects with 19 implants. The age of all subjects ranged between 40-60 years with a mean age 51±4.70. All subjects underwent a follow up CT scan using PlanmecaPromax 3D ®Cone beam computed tomography scanner at the Radiology department, Hospital University Sains, Malaysia. The collected data was then analysed to evaluate bone density in Hounsfield Units using PlanmecaRomexis™ Imaging Software 2.2 ®which is specialized accompanying software of the cone beam computed tomography machine. Results: There was bone formation seen at the site of the augmented sinus. A significant increase (p

Background: To assess role of immunohistochemistry in identifying primary and secondary ovarian malignancies. Methods: In this descriptive cross sectional study 65 cases of ovarian malignancies diagnosed during the year 2001, with a limited immunohistochemistry support were included. An equal number of cases (65 cases) diagnosed during the year 2012, with an extended immunochemistry support, were used for the comparison. Immunostains used in these cases were CK, CK7, CK20, Cdx2, PLAP, WT1, inhibin, Calretenin, Melan A, CD99, GCDFP15, Mammoglobin LCA, CEA, AFP, CD30 and CD10. Results: The frequency of metastatic carcinoma has changed tremendously being 3% in 2001 and 35.4% in 2012. The frequencies of other malignancies in 2001 in descending order of frequency were surface epithelial tumour (74.2%), germ cell tumours (16.2%), sex cord stromal tumours (1.5%) and others (3%). In 2012, apart from metastatic carcinoma, the frequency in descending order of frequency was surface epithelial tumours (35.4%), germ cell tumours (18.5%), sex cord stromal tumours (16.2%), and others (4.6%). There was not much difference in median ages (42.74 +15.4 and 39.54 + 15.8) Conclusion: IHC has helped in identifying primary and secondary ovarian malignancies.

The aim of the present study is to investigate the effect of flow parameters on the free convection and mass transfer of an unsteady magnetohydrodynamic flow of an electrically conducting, viscous and incompressible fluid past an infinite vertical porous plate in the presence of variable suction. The thermal radiation and chemical reaction effects are assumed to exist within the channel. Non dimensional partial differential equations of governing equations of flow are solved numerically using Crank Nicolson finite difference method. The skin friction, heat and mass transfer rates as well as the effects of various parameters on velocity, temperature and concentration profiles are analyzed. The signifiant results from this study are that an increase in the values of radiation parameter and chemical reaction parameter causes a reduction in the velocity, temperature and concentration.

Background. Calcific uremic arteriolopathy (CUA) or calciphylaxis though generally noted for its high mortality, recent case reports have shown promising results using single agent therapies. However, it is not clear whether combination therapeutic agents will improve course of the disease. Objective. To determine clinical outcome in subjects with CUA on multimodal treatment. Methods. All patients with end-stage renal failure (ESRF) at The Townsville Hospital, Australia, from April 1, 2006, to March 31, 2011, with diagnosis of CUA were retrospectively studied. Results. Six subjects with CUA (4 females and 2 males) were on various combination therapeutic agents comprising sodium thiosulphate, hyperbaric oxygen, prednisolone, cinacalcet, and parathyroidectomy in addition to intensified haemodialysis, specialist local wound care, and antibiotics. The wounds failed to heal in 3 patients while 5 of the 6 subjects died; cause of death being sepsis in 3 and myocardial infarction in 2. Conclusion. Prognosis of CUA remains poor in spite of multimodal combination therapy. Further prospective studies on a larger population are needed to verify our findings.

We present a case of highly elevated tenfold rise of serum chromogranin A in a young, morbidly obese, hypertensive female being investigated for pancreatic mass, weight loss, and elevated ESR. Following extensive noninvasive investigations, an ultrasound-guided pancreatic biopsy confirmed benign haemorrhagic cyst. A clue to the etiology of the hyperchromogranin A was the elevated serum gastrin level leading to suspicion of proton pump inhibitor administration confirmed by admittance to its use. Withdrawal of the medication led to dramatic resolution of the neuroendocrine tumor marker.

Background: Acral and mucosal melanomas, the most common sun-shielded site melanoma subtypes in Asia and Indonesia, often yield poor prognoses. The invasion depth reflects their progressivity, and the pathogenesis is influenced by vitamin D receptor (VDR) status and CD8+ T-Lymphocyte amount. This study aims to determine the association between the invasion depth of acral and mucosal melanomas with their VDR and CD8+ immunoexpression., Methods: A cross-sectional observational study was conducted on 60 formalin-fixed paraffin-embedded (FPPE) samples, with equal representation in acral and mucosal melanoma groups from 2017 to 2021. The samples were assessed for the invasion depth and immunoexpression of VDR and CD8+. A chi-square test with an alternative Exact-Fisher analysis was used to determine the association between the variables in both subtype groups., Results: An association between VDR and CD8+ immunoexpression and invasion depth in acral melanoma (p value = 0.0001 and 0.009, respectively) was observed, while only VDR immunoexpression was associated with the invasion depth in mucosal melanoma (p-value =0.004). Interestingly, no association was found between CD8+ immunoexpression and the invasion depth in mucosal melanoma (p = 0.640)., Conclusion: The role of VDR and CD8+ T-lymphocytes are inversely associated with melanoma depth in acral melanoma, while only VDR is associated with melanoma depth in mucosal melanoma., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Breastfeeding is crucial in providing infants with needed nutrition and immunity to foster their healthy growth and development; yet, optimal support from health workers is critical for it to be successful., Aim: To determine factors influencing tangible breastfeeding support among health workers in Nigeria., Methods: This cross-sectional study was conducted in Nigeria's six geopolitical zones between August 2022 and February 2023 among health workers ( N  = 2,922). Data were gathered through an interviewer-administered, validated questionnaire. Significant factors of tangible breastfeeding support were identified through multivariable logistic regression, and corresponding odds ratios with 95% confidence intervals were reported., Results: The mean age of the health workers was 28.6 ( SD  = 9.3) years. Just 45% (1,316) achieved optimal scores for tangible breastfeeding support. Only 31.4% (918) of lactation support providers/specialists practice tangible breastfeeding support and half (50.6%, 1,479) had a favorable attitude towards providing tangible breastfeeding support. About two-fifths (39.3%, 1,148) engaged caregivers in reviewing breast milk storage procedures, whereas, 54.6% (1,595) and 78.0% (2,279) of health workers assisted with breast pumps and breastfeeding attachment respectively. The odds of having optimal tangible breastfeeding support were higher for health workers aged 52 years or older compared to those aged under 20 years (aOR 1.88, 95% CI [1.13, 3.12]), a positive attitude (aOR 1.43, 95% CI [1.22, 1.69]), availability of a breastfeeding champion (aOR 1.47, 95% CI [1.21, 1.79]), 1.69]), provision of breast-pump videos (aOR; 2.33, 95% CI [1.85, 2.95]), and hand-expression videos (aOR; 1.41, 95% CI [1.02, 1.79]). (duplication)., Conclusion: Health workers' tangible breastfeeding support in Nigeria is suboptimal and is driven by age, service level, attitude, availability of breastfeeding champions, and appropriate practice aids. Targeted interventions to improve health workers' attitudes, technical skills, provision of aids, and task shifting to non-specialists are needed for optimal tangible breastfeeding support., Competing Interests: Disclosures and Conflicts of InterestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Langerhans cell histiocytosis (LCH) is a rare clonal disorder of the monocyte-macrophage system. There are 3 distinct types of LCH: multisystem type (MS), single-system multi-site (SS-m), and single-system single-site (SS-s). The disease is most common in young children, especially males. In this case, we report the rare case of a young Asian girl who initially complained of dyspnea, diarrhea, rash, and fever. Upon further examination, multiple systems were implicated, including the bone, skin, lung, liver, and spleen. Multisystem LCH with risk organ involvement give poor prognosis to the patients., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Aneurysmal bone cyst (ABC) is a benign and locally proliferative vascular disorder in the form of a non-neoplastic bone lesion commonly found in children and young adults. Several treatments and therapeutic options are available. Percutaneous sclerotherapy is an alternative treatment for ABC with less morbidity than other therapies. An 11-year-old girl presented with a lump in her left flank since 10 months ago with paresthesia, and leg weakness. The patient was unable to raise her legs and walk. The patient underwent posterior surgical and stabilization procedures with tumor extirpation. Three months postsurgery, the lump progressively increased and tenderness. MRI showed an expansile destructive lytic lesion, firm borders, regular margins, and multiple septa with clear transition zones, without periosteal reactions, forming a picture of a "soap bubble appearance" surrounding the lumbar paravertebral. The patient underwent sclerotherapy using 5 ml of absolute alcohol under visual fluoroscopy guidance. After the sclerotherapy, the patient showed clinical improvement and decreased lump size. No side effects or massive bleeding were experienced postsclerotherapy. Thoracolumbar x-ray post sclerotherapy showed a decreased mass size in the posterior lumbar area. This case demonstrates that sclerotherapy presents a secure alternative for pediatric patients in contrast to spinal ABC surgery. It offers minimal invasiveness and reduced morbidity. The percutaneous administration of absolute alcohol proves effective in treating spinal ABC. In this case, the patient experienced clinical improvement, leading to a decrease in lump size. There were no instances of significant bleeding around the lump postsclerotherapy., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Sub-Saharan Africa (SSA) is plagued by myriads of diseases, mostly infectious; but cancer disease burden is rising among non-communicable diseases. Nigeria has a high burden of cancer, however its remote underserved culturally-conserved populations have been understudied, a gap this study sought to fill., Methods: This was a cross-sectional multi-institutional descriptive study of histologically diagnosed cancers over a four-year period (January 2019-December 2022) archived in the Departments of Pathology and Cancer Registries of six tertiary hospitals in the northeast of Nigeria. Data obtained included age at diagnosis, gender, tumor site and available cancer care infrastructure. Population data of the study region and its demographics was obtained from the National Population Commission and used to calculate incident rates for the population studied., Results: A total of 4,681 incident cancer cases from 2,770 females and 1,911 males were identified. The median age at diagnosis for females was 45 years (range 1-95yrs), and 56 years (range 1-99yrs) for males. Observed age-specific incidence rates (ASR) increased steadily for both genders reaching peaks in the age group 80 years and above with the highest ASR seen among males (321/100,000 persons) compared to females (215.5/100,000 persons). Breast, cervical, prostatic, colorectal and skin cancers were the five most common incident cancers. In females, breast, cervical, skin, ovarian and colorectal cancers were the top five malignancies; while prostate, haematolymphoid, skin, colorectal and urinary bladder cancers predominated in men., Conclusion: Remote SSA communities are witnessing rising cancer disease burden. Proactive control programs inclusive of advocacy, vaccination, screening, and improved diagnostics are needed., 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. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Ezenkwa, Lawan, Garbati, Suleiman, Katagum, Kabir, Adamu, Modu, Olanrewaju, Dachi, Abdullahi, Alkali, Bojude, Usman, Omotoso, Schlumbrecht, George and Audu.)

Background: Post-abortion care (PAC) is a crucial component of emergency obstetric care, and many of the primary health care centres (PHC) in the internally displaced person (IDP) camps and host communities in Maiduguri lack it. Improved access to high-quality PACs is essential for meeting the reproductive health needs of the IDPs and reducing the maternal morbidity and mortality that can result from miscarriages. OBJECTIVE: To determine the trend in managing miscarriages in the IDP camps and host communities in Maiduguri and the impact of the volunteer obstetrician scheme (VOS) on PAC., Methodology: We conducted a longitudinal study in selected PHCs serving IDP camps and host communities in Maiduguri. The study spanned five (5) years, and we compared the management of miscarriages and PAC services one year before the VOS project, two years during the project and two years after the project. During the two-year VOS project, staff manning the PHCs had supportive supervision with hands-on training on PAC. Chi-square for trend and odd ratio with a 95% confidence interval was used as appropriate to compare the trend in PAC services provided during the study period., Results: One thousand eight hundred and eight (1808) women presented with miscarriages, and 1562 (86.4%) required uterine evacuation. Medical evacuation with oral misoprostol was offered to 974 (62.4%), and manual vacuum aspiration (MVA) was used in 422 (27.0%) of the women who needed uterine evacuation. There was a statistically significant rise in the use of medical evacuation throughout the study period (52.2% before VOS, and 71.4% by the second year of VOS) with ꭓ2=41.64 and P<0.001. In comparison, the use of MVA fell from 38.6% in 2015 to 27.7% in 2019 (ꭓ2=34.74 and P<0.001). Similar rising trends were also observed in postabortion family planning acceptance (ꭓ2=22.27, P<0.001)., Conclusion: The Volunteer Obstetrician Scheme project appears to have improved PAC services, especially medical evacuation and family planning uptake in the PHCs in IDP camps and host communities in Maiduguri, Borno State, Nigeria. We recommend task shifting of PAC services and periodic supportive supervision to ensure the quality of care., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Individuals with human immunodeficiency virus (HIV) infection are prone to developing persistent and unremitting anogenital warts (AGWs). To address this health condition, immunotherapy using tuberculin purified protein derivative (PPD) has been proven to be a promising novel and safe treatment for AGWs in HIV patients. Therefore, this study involved a case of a 21-year-old man with stage I HIV infection, possessing CD4 counts 548 cells/uL and routinely receiving HIV antiretroviral. Patients presented with a condyloma acuminata type AGWs, supported by histopathological results, and tested positive for Human papillomavirus type 11. The treatment approach involved administering 15 tuberculin units of PPD weekly to the largest lesion for 5 weeks. The lesion started to respond two weeks following the first injection and showed a 50% decrease in size after five weeks. There was pain on the site of injection and sub-febrile for a short period. In conclusion, tuberculin PPD is safe and has the potential for the treatment of AGWs in HIV-positive patients for further development., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest., (Copyright © 2023, the Author(s).)

Background: Cervical cancer is the fourth most common cancer among women globally, with quality of life (QOL) being a major concern for patients with cervical cancer, especially in low- and middle-income countries (LMICs). This is largely due to the advanced nature of the disease at presentation. Although there are a higher number of studies focusing on the QOL of high-income countries, the QOL of cervical cancer patients in LMICs is not available. The aim of this study is to evaluate QOL among women with cervical cancer in Nigeria using a 2-point assessment., Methods: A multi-center prospective cohort study will be conducted in 6 tertiary health facilities randomly selected from the 6 geopolitical zones of Nigeria and consisting of a 2-point assessment of the QOL of participants at the time of diagnosis of cervical cancer and after treatment. Women who were recently diagnosed with histologically confirmed cervical cancer (treatment naïve) will be included. QOL will be assessed using Quality of Life Questionnaire domains (EORTC QLQ30) as developed by the European Organization for Research and Treatment of Cancer (EORTC). In addition to the QOL assessment, relevant and clinicopathological variables will be obtained using a self-structured data extraction sheet designed for this study. All data will be anonymized and will be analyzed using SPSS version 25. Levels of QOL will be calculated using EORTC QLQ30. Ethical approval was obtained from National Health Research Ethics Committee (NHREC/01/01/2007-08/11/2021)., Discussion: In view of the paucity of data on QOL in LMICs like Nigeria, where most women with cervical cancer present with advanced disease, this research was designed to help in formulating evidence-based interventions to improve the QOL and treatment outcomes provided to women with cervical cancer in Nigeria and other LMICs. The study is expected to fill these knowledge gaps., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Objective: We systematically identified the prevalence of triplex infections (combined human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)) in pregnancy., Methods: To gather information on the frequency of triplex infections, we searched the databases of PubMed, CINAHL, and Google Scholar. Without regard to language, we utilized search terms that covered HIV, HBV, HCV, and pregnancy. Pregnant women with triplex infections of HIV, HBV, and HCV were included in studies that also examined the prevalence of triplex infections. Review Manager 5.4.1 was employed to conduct the meta-analysis. Critical appraisal and bias tool risk data were provided as percentages with 95% confidence intervals (95% CIs), and I 2 was used as the statistical measure of heterogeneity. The checklist was created by Hoy and colleagues. The study protocol was registered on PROSPERO, under the registration number CRD42020202583., Results: Eight studies involving 5314 women were included. We identified one ongoing study. Pooled prevalence of triplex infections was 0.03% (95% CI: 0.02-0.04%) according to meta-analysis. Subgroup analysis demonstrated a significantly high prevalence of 0.08% (95% CI: 0.06-0.10%; 3863 women) in HIV-positive population than 0.00% (95% CI:-0.00-0.00; 1451 women; P < 0.001) in general obstetric population. Moreover, there was a significant difference in the pooled prevalence between studies published between 2001 and 2010 and between 2011 and 2021 (0.14% (95% CI: 0.12 to 0.16 versus 0.03% (95% CI: 0.02 to 0.04%; P < 0.001))) and participants recruited in the period between 2001 and 2011 and between 2012 and 2021 (0.13% (95% CI: 0.05 to 0.21; p =0.002 versus 0.00% (95% CI: -0.00 to 0.00%; p =1.00))), respectively., Conclusion: The combined prevalence of prenatal triplex infections was 0.03%, with rates notably higher among the group of pregnant women who were HIV-positive and during the recruitment period that took place before 2012. This prevalence still necessitates screening for these infections as necessary., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 George Uchenna Eleje et al.)

Diagnosis of nodular red lesions is challenging. The differential diagnosis includes dermal nevus, angioma, pyogenic granuloma, amelanotic melanoma, eccrine poroma, Kaposi's sarcoma, skin malignancy or metastasis. Erythema nodosum is one of the common consideration of the red skin nodules, however fully work up should be done to find the right diagnosis.A 60 years old female admitted to our hospital due to pain dark reddish skin nodules since one month. She had continuously high grade fever of 39 Celsius accompanied by arthralgia and fatigue since two months prior to admission and she lost 6 kg of weight in 2 months. On admission, physical examination revealed slight fever, pale conjunctiva, mild hepatosplenomegaly, tender dark red nodules 0.3 to 2 cm, firm edge, at her cheek, abdominal area and both lower extremities. No lymph nodes enlargement was noticed. Her laboratory test showed haemoglobin 9,1 g/dl, WBC 3,040/mL, PLT 149,000/mL, SGOT 48 U/L, SGPT 43 U/L, urea 12.5 mg/dL, creatinine 0.67 mg/dL. She was found to be non-reactive for HBsAg, HCV, and HIV antigens. Urine routine and microscopic examination was unremarkable.Her histopathology of left foot nodule biopsy revealed cutaneous lymphoma. The immunohistochemical (IHC) stain of CD45, CD20, and CD10 were positive, Ki67 were also positive  with >70% tumor cells, while CD3,CD56, CD30, and Granzyme were negative. Her final diagnosed was Cutaneous Diffuse large B cell lymphoma.Primary cutaneous lymphomas of B-cells occur less frequently than primary cutaneous T-cells lymphomas. Primary extra-nodal diffuse large B-Cell lymphoma (DLBCL) can be seen in up to 40% of cases. However skin involvement is less common and in a large cohort of DLBCL cases, skin involvement at presentation was seen only in 3.3% of cases.It characterized by few lesions, in general showing nodules or infiltrations of relatively fast growth and have no itching. The diagnosis is made by the immunohistochemical findings, clinicopathological correlation, and molecular pathology.  The lymphomas have different clinical behaviours despite being identical in morphological appearance. The primary lymphomas presents with local recurrence in up to 68% of the cases and with rare extra-cutaneous dissemination, with an average rate of 5-year survival varying from 89 to 96%. Cutaneous lymphoma should be always become one of considered diagnosed of skin red nodules even it is rare.

Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Objectives: To systematically review literature and identify mother-to-child transmission rates of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among pregnant women with single, dual, or triplex infections of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Nigeria. PRISMA guidelines were employed. Searches were on 19 February 2021 in PubMed, Google Scholar and CINAHL on studies published from 1 February 2001 to 31 January 2021 using keywords: "MTCT," "dual infection," "triplex infection," "HIV," "HBV," and "HCV." Studies that reported mother-to-child transmission rate of at least any of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among pregnant women and their infant pairs with single, dual, or triplex infections of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Nigeria irrespective of publication status or language were eligible. Data were extracted independently by two authors with disagreements resolved by a third author. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary mother-to-child transmission rates in terms of percentage with 95% confidence interval. Protocol was prospectively registered in PROSPERO: CRD42020202070. The search identified 849 reports. After screening titles and abstracts, 25 full-text articles were assessed for eligibility and 18 were included for meta-analysis. We identified one ongoing study. Pooled mother-to-child transmission rates were 2.74% (95% confidence interval: 2.48%-2.99%; 5863 participants; 15 studies) and 55.49% (95% confidence interval: 35.93%-75.04%; 433 participants; three studies), among mother-infant pairs with mono-infection of human immunodeficiency virus and hepatitis B virus, respectively, according to meta-analysis. Overall, the studies showed a moderate risk of bias. The pooled rate of mother-to-child transmission of human immunodeficiency virus was 2.74% and hepatitis B virus was 55.49% among mother-infant pairs with mono-infection of HIV and hepatitis B virus, respectively. No data exists on rates of mother-to-child transmission of hepatitis C virus on mono-infection or mother-to-child transmission of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among mother-infant pairs with dual or triplex infection of HIV, hepatitis B virus and HCV in Nigeria., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objective: Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora., Methods: Patients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at p<0.05., Results: Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01)., Conclusion: There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation., 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 © 2021 George, Omotoso, Pinto, Mustapha, Sanchez-Covarrubias, Umar, Umar, Oluwasola, Okolo, Anthony, Ukekwe, Bakari, Dahiru, Abdullahi, Abimiku, Abdurrahman, Usman, Ahmed, Usman, Kabir, Eleje, Chiemeka, Nzeribe, Nweke, Kadas, Suleiman, Ekanem, Uche, Paul, Agwu, Edegbe, Anorlu, Banjo, Ajenifuja, Fawole, Kazeem, Magaji, Silas, Athanasius, Tamunomie, Bassey, Abudu, Ango, Abdullahi, Lawal, Kabir, Ekanem, Ezeanochie, Yahaya, Castillo, Bahall, Chatrani, Brambury, Bowe, Halliday, Bruney, Butler, Ragin, Odedina, Chamala, Schlumbrecht and Audu.)

Objective: To determine the hepatitis B vaccination coverage, full-dose (⩾3) coverage and the associated factors affecting uptake among pregnant women., Methods: This was a cross-sectional study among pregnant women attending antenatal care in six tertiary hospitals across all the geopolitical zones of Nigeria. Pregnant women who consented to the study completed screening questions about their hepatitis B vaccination status and coverage. The main outcome measures were hepatitis B vaccination coverage rate, dose, and factors affecting uptake. Bivariate analysis was performed by the chi-square test and conditional logistic regression analysis was used to determine variables associated with uptake of the vaccination. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated and statistical significance was accepted when p -value was < 0.05., Results: Of 159 pregnant women who completed the interview questions, 21 [13.2%, 95% confidence interval (CI) 7.9-18.5%] were vaccinated for hepatitis B for one to three doses. The numbers of doses received were: three doses (8/159, 5.0%), two doses (5/159, 3.1%), and one dose (8/159, 5.0%). The reasons for non-uptake of vaccination included: lack of awareness of the vaccine 83/138 (60.1%), inadequate access to vaccine 11/138 (8.0%), and positivity to hepatitis B virus 10/138 (7.2%). The uptake of hepatitis B vaccination was significantly affected by the level of education (OR 0.284, 95% CI 0.08-1.01, p  = 0.041), but in multivariable logistic regression, adjusted for confounders, the association between hepatitis B vaccination and participants' level of education (aOR 3.09; 95% CI 0.95-10.16; p  = 0.061) did not remain significant., Conclusions: In Nigeria, the national hepatitis B vaccination coverage among pregnant women appears poor, with the full-dose coverage even poorer. The level of education was not positively associated with uptake of hepatitis B vaccination, while lack of awareness of the vaccine was the commonest reason for non-uptake., Funding: TETFund National Research Fund 2019 (grant number TETFund/DR&D/CE/NRF/STI/33)., Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest., (© The Author(s), 2021.)

Objective: This study aimed to investigate the cytotoxicity, anti-proliferation and anti-migration effect of the ethanol extract of Aaptos suberitoides on trastuzumab-resistant HER2+ breast cancer cell line., Methods: Aaptos suberitoides was collected from Tinjil Island, Banten, Indonesia, and was processed with maceration and ethanol extraction. HCC-1954 cells were treated with the ethanol extract and then followed by 3- [4, 5-dimethylthiazol-2-yl] -2.5 diphenyl tetrazolium bromide (MTT) assay to assess cytotoxicity, clonogenic assay and three-dimensional (3D) spheroid assay to evaluate anti-proliferative effect in two-dimensional and 3D model, respectively, and wound healing assay to determine anti-cell migration effect. Four parametric regression was used to analyse the IC50., Results: This study revealed that the ethanol extract of Aaptos suberitoides suppressed cell viability in correlation with cell death induction. The IC50 values of the ethanol extract of Aaptos suberitoides using MTT assay and clonogenic assay were 12.0 ppm and 4.36 ppm, respectively. The extract demonstrated an inhibition effect on spheroid growth. In low concentration, the extract of Aaptos suberitoides inhibited cell migration. Furthermore, MS analysis showed that the most abundant compounds in this extract has molecular weight m/z 229.81 [M+H]+., Conclusion: This study revealed that the ethanol extract of Aaptos suberitoides demonstrates cytotoxicity, anti-proliferation and anti-migration effect as well as inhibition effect on three-dimensional spheroid growth in trastuzumab-resistant HER2+ breast cancer cell line., .

Background: There are no national data on hepatitis C virus awareness and burden among pregnant women to justify its routine screening., Objectives: To investigate awareness, seroprevalence and risk factors for hepatitis C virus infection among pregnant women in Nigeria., Methods: A total of 159 pregnant women from antenatal clinics across six geopolitical zones in Nigeria consented to anti-hepatitis C virus testing which was confirmed using polymerase chain reaction technique. Confirmed hepatitis C virus positive women were further tested for hepatitis B and HIV. Participants were evaluated for risk factors for hepatitis C virus. Odds ratios, adjusted odds ratios, and their 95% confidence intervals (CIs) were determined, and p-values of <0.05 were considered significant., Results: Of 159 participants, 77 (48.4%; 95% confidence interval = 38.2%-60.5%) were aware of hepatitis C virus infection and awareness of hepatitis C virus was associated with young age (odds ratio = 2.21; 95% confidence interval = 1.16-4.21), high educational level (odds ratio = 3.29; 95% confidence interval = 1.63-6.64), and participants' occupation (odds ratio = 0.51; 95% confidence interval = 0.26-0.99). In multivariable logistic regression, adjusted for confounders, the association between awareness of hepatitis C virus and participants' young age (adjusted odds ratio = 1.60; 95% confidence interval = 1.09-2.35; p = 0.018) and high educational level (adjusted odds ratio = 1.48; 95% confidence interval = 1.17-1.86; p = 0.001) remained significant. Hepatitis C virus seroprevalence was found to be 1.3% (95% confidence interval = 0.2%-4.5%). All (100.0%, 95% confidence interval = 12.1%-100.0%) the hepatitis C virus-positive participants and 99 (63.1%, 95% confidence interval = 51.3%-76.8%) hepatitis C virus-negative participants had identifiable hepatitis C virus risk factors. Dual seropositivity of anti-hepatitis C virus/anti-HIV and anti-hepatitis C virus/hepatitis B surface antigen each accounted for 0.6%. The most identified risk factors were multiple sexual partners (15.7%), shared needles (13.8%), and blood transfusion (11.3%). There was no significant association between the risk factors and hepatitis C virus positive status., Conclusion: Awareness of hepatitis C virus infection among pregnant women in Nigeria is low and those aware are positively influenced by young age and high educational level. The prevalence of hepatitis C virus infection is high and provides preliminary evidence to justify antenatal routine screening.

Background: Nigeria contributes significantly to the global burden of HIV, Hepatitis B and C infections, either singly or in combinations, despite progress in HIV care regionally and globally. Although some limited data on mono infection of HIV, Hepatitis B and C virus infections do exists, that of dual and triplex infections, including seroconversion and mother-to-child transmission (MTCT) rates necessary for planning to address the scourge of infections in pregnancy are not available., Objectives: To determine the seroprevalence, rate of new infections, MTCT of dual and triple infections of HIV, Hepatitis B and C viruses and associated factors, among pregnant women in Nigeria., Method: A multicenter prospective cohort study will be conducted in six tertiary health facilities randomly selected from the six geopolitical zones of Nigeria. All eligible pregnant women are to be tested at enrollment after informed consent for HIV, Hepatitis B and C virus infections. While those positive for at least two of the infections in any combination will be enrolled into the study and followed up to 6 weeks post-delivery, those negative for the three infections or positive for only one of the infections at enrolment will be retested at delivery using a rapid diagnostic test. On enrolment into the study relevant information, will be obtained, and laboratory test of CD4 count, liver function test and full blood counts, and prenatal ultrasonography will also be obtained/performed. Management of mother-newborns pairs will be according to appropriate national guidelines. All exposed newborns will be tested for HIV, HBV or HCV infection at birth and 6 weeks using PCR technique. The study data will be documented on the study case record forms. Data will be managed with SPSS for windows version 23. Ethical approval was obtained from National Health Research Ethics Committee (NHREC) (NHREC/01/01/2007-23/01/2020)., Conclusion: Pregnant women with multiple of HIV, HBV and HCV infections are at increased risk of hepatotoxicity, maternal and perinatal morbidity and mortality. Additionally, infected pregnant women transmit the virus to their unborn baby even when asymptomatic. Children born with any of the infection have significantly poorer quality of life and lower five-year survival rate. Unfortunately, the seroconversion and MTCT rates of dual or triplex infections among pregnant women in Nigeria have not been studied making planning for prevention and subsequent elimination of the viruses difficult. The study is expected to fill this knowledge gaps. Nigeria joining the rest of the world to eliminate the triple infection among children rest on the availability of adequate and reliable data generated from appropriately designed, and powered study using representative population sample. The establishment of the three-in-one study of prevalence, rate of new infection, rate and risk factor for MTCT of dual and triple infection of HIV, Hepatitis B and C viruses among pregnant women in Nigeria is urgently needed for policy development and planning for the improvement of the quality of life of mothers and the elimination of childhood triplex infection.

Objective: To evaluate whether teaching mothers about neonatal jaundice will decrease the incidence of acute bilirubin encephalopathy among infants admitted for jaundice., Study Design: This was a multicenter, before-after and cross-sectional study. Baseline incidences of encephalopathy were obtained at 4 collaborating medical centers between January 2014 and May 2015 (Phase 1). Structured jaundice instruction was then offered (May to November 2015; Phase 2) in antenatal clinics and postpartum. Descriptive statistics and logistic regression models compared 3 groups: 843 Phase 1 controls, 338 Phase 2 infants whose mothers received both antenatal and postnatal instruction (group A), and 215 Phase 2 infants whose mothers received no instruction (group B) either because the program was not offered to them or by choice., Results: Acute bilirubin encephalopathy occurred in 147 of 843 (17%) Phase 1 and 85 of 659 (13%) Phase 2 admissions, which included 63 of 215 (29%) group B and 5 of 338 (1.5%) group A infants. OR for having acute bilirubin encephalopathy, comparing group A and group B infants adjusted for confounding risk factors, was 0.12 (95% CI 0.03-0.60). Delayed care-seeking (defined as an admission total bilirubin ≥18 mg/dL at age ≥48 hours) was the strongest single predictor of acute bilirubin encephalopathy (OR 11.4; 6.6-19.5). Instruction decreased delay from 49% to 17%. Other major risk factors were home births (OR 2.67; 1.69-4.22) and hemolytic disease (hematocrit ≤35% plus bilirubin ≥20 mg/dL) (OR 3.03; 1.77-5.18). The greater rate of acute bilirubin encephalopathy with home vs hospital birth disappeared if mothers received jaundice instruction., Conclusions: Providing information about jaundice to mothers was associated with a reduction in the incidence of bilirubin encephalopathy per hospital admission., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The tumor microenvironment including immune surveillance affects malignant melanoma (MM) behavior. Nuclear factor κB (NF-κB) stimulates the transcription of various genes in the nucleus and plays a role in the inflammatory process and in tumorigenesis. CD8 + T cells have cytotoxic properties important in the elimination of tumors. However, inhibitory receptors on the cell surface will bind to programmed death-ligand 1 (PD-L1), causing CD8 + T cells to lose their ability to initiate an immune response. This study analyzed the association of NF-κB and PD-L1 expression levels and CD8 + T-cell counts with depth of invasion of acral MM, which may be a predictor of aggressiveness related to an increased risk of metastasis., Methods: A retrospective cross-sectional study was conducted in the Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital using 96 cases of acral melanoma. Immunohistochemical staining was performed on paraffin blocks using anti-NF-κB, -PD-L1, and -CD8 antibodies and invasion depth was measured using dotSlide-imaging software., Results: The study showed significant associations between the individual expression of NF-κB and PD-L1 and CD8 + T-cell number, with MM invasion depth. NF-κB was found to be a confounding variable of CD8 + T-cell number (p < .05), but not for PD-L1 expression (p = .154). Through multivariate analysis it was found that NF-κB had the greatest association with the depth of invasion (p < .001), whereas PD-L1 was unrelated to the depth of invasion because it depends on the number of CD8 + T cells (p = .870)., Conclusions: NF-κB plays a major role in acral MM invasion, by decreasing the number of CD8 + T cells in acral MM.